Patient Forms
Submit Online
New Patient Information Forms
6 Month Checkup Form
Print and Bring In
New Patient Information Forms
- New Patient Introductory Sheet [English - Print] | [Spanish - Print]
- Health History - Print
- Our Three Commitments / Financial Arrangements [English] | [Spanish]
- Facts About Dental Insurance
- Notice of Privacy Practices
Authorization Forms
- 6 Month Checkup Form
- Sealant Authorization Form
- Medical / Dental Release Form
- Photo / Web Release Form
- Caregiver Authorization
Accessibility Statement
If you’re unable to open PDF files, you can get Adobe Reader® for free.
Share Your Experience with Us
See our practice through the eyes of our patients! Share your experiences with
Pediatric Dental Specialists using the hashtag #PDSLongBeach
Patient Testimonials
Everyone at your office is very friendly and professional, caring and understanding. Your work to accommodate children with special needs is highly commendable and appreciated tremendously.
Andrew K.Dr. Cortez is amazing! His gentle nature makes going to the dentist a joy for both of our kids! The dental hygienists are quick and efficient with cleanings, so the kids are finished before even thinking about it. The office staff is amazing as well!
Isabella L.Dr. Sanchez is a superb dentist who took the time to explain to my child exactly what she needed to do to maintain acceptable oral health. Words from a caring professional work better than ‘nagging’ from mom! Thank you!
Elena M.
