Please Fill out the below form to get started with our office

At Discovery Dental, we value our patients office and treatment experience, comfort and care above all else! Our New Patient Forms are the start to our new relationship with you and your family, please be sure to fill out all of the below documents with as much detail as possible, so we can ensure your treatment care will be comfortable!

If you need assistance or have questions about our New Patient Forms please call us at the following number: (760) 471-2231

Patient Dental & Medical History

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Step 1 of 2 - Patient Dental History

Name*

Welcome! Please complete both pages of this dental/medical history form so that we may provide you with the best possible dental care. All information is completely confidential.
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Have you ever used or are you currently using topical fluoride?
Do you have any dental problems now?

Are any of your teeth sensitive to:
Hot or cold?
Sweets?
Biting or chewing?
Have you noticed any mouth odors or bad taste?
Do you frequently get cold sores, blisters or any other oral lesions?
Do your gums bleed or hurt?
Have your parents experienced gum disease or tooth loss?
Have you noticed any loose teeth or change in your bite?
Does food tend to become caught in between your teeth?

Do you:
Clench or grind your teeth while awake or asleep?
Bite your lips or cheeks regularly?
Hold foreign objects with your teeth (pencils, pipe, pins, nails, fingernails)?
Mouth breathe while awake or asleep?
Have tired jaws, especially in the morning?
Snore or have any other sleeping disorders?
Smoke/chew tobacco or use other tobacco products?

Have you ever had:
Orthodontic treatment?
Oral surgery?
Periodontal treatment?
Your teeth ground or the bite adjusted?
A bite plate or mouth guard?
A serious injury to the mouth or head?

Have you experienced:
Clicking or popping of the jaw?
Pain (joint, ear, side of face)?
Difficulty in opening or closing the mouth?
Difficulty in chewing on either side of the mouth?
Headaches, neck aches or shoulder aches?
Sore muscles (neck, shoulders)?
Are you satisfied with your teeth’s appearance?
Would you like to keep all of your teeth all of your life?
Do you feel nervous about having dental treatment?
Have you ever had an upsetting dental experience?
Have you ever been told to take a pre-medication prior to dental treatment?
Is there anything else about having dental treatment that you would like us to know?


READ WHAT OUR PATIENTS ARE SAYING....

“I recently visited Discovery Dental and I am beyond impressed with my experience. From the moment i walked in, I was greeted warmly by the receptionist. The waiting area was clean and comfortable.
The dentist Dr. Alkhayat was very friendly and knowledgeable. He took the time to answer all of my questions and explained everything he was doing. I was so comfortable throughout my entire appointment.”

Hala Mazin / Google

“Great experience for my regular cleaning a couple weeks ago. Fatima make you feel like family as soon as you walk in the door. She is also a pleasure to speak to on the phone when setting up appointments. Dr. K and the rest of his staff are great, very friendly and explain everything to you in a manner that is easy to understand. Great place. If you’re looking for a dentist this is the place!”

Michael Guerrero / Google

“I would absolutely recommend Discovery Dental! The entire team is so kind, caring, and welcoming, and they genuinely care about their patients. I have always had anxiety going to the dentist, but now I look forward to going to my appointments. They are seriously the best!”

Cassidy Melkonian / Google

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