New Patient Forms

Welcome to Brush N Brace! Thank you for choosing us for your dental and/or orthodontic needs. In order that we can give you the very best care possible and to help us to prepare your dental visit with us, we ask that your parent/guardian fill out all needed information in the screens below. If you have any questions you can always call our office at: (858) 800-2000 and we’ll be more than happy to help you out.
All information is transmitted over a secure connection and will never be distributed or sold to any third parties. We are compliant and observe all HIPAA Regulations.

We also have a short form for you to fill out (see button below). We want to make your visit as personalized and give you the quality care you deserve. All answers will be kept confidential.

Thank you!

If your parent/guardian is unable to fill out the New Patient Form Online, you can download it here and email it to us at:

We do ask that you fill it out and email the form to us as soon as possible so that we can have everything ready for your appointment.

Please save the file to your computer and open the file with Adobe Reader. If you do not have Adobe reader installed on your computer, you can download it for free at:

Once the file is open in Adobe Reader, please type in your answers and save file. You don’ need to worry about signing the form, we can do that here at the office.


New Patient Information and Health History Form

Contact Us

We're not around right now. But you can send us an email and we'll get back to you, asap.

Not readable? Change text. captcha txt