Now accepting Telehealth appointments. Schedule a virtual visit.

Forms

Kari L. Sakurai, DDS, Inc. Contents Patients Forms

 

NEW PATIENT FORMS (to print and bring to your visit): 

New Patient Information1.pdf

New Patient Information2.pdf

FINANCIAL POLICY.pdf

HIPAA.pdf

Dental Materials Fact Sheet.pdf


NEW PATIENTS WITH AN APPOINTMENT (digital forms):

Please complete form digitally here.

Location
Pacific View Smile Center
2811 Wilshire Blvd., Suite 590
Santa Monica, CA 90403
Phone: 310-620-9650
Fax: 310-453-6612
Office Hours

Get in touch

310-620-9650