PATIENT REFERRAL FORM

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During your visit, a thorough examination and x-rays will be conducted to make an accurate diagnosis.
If you have dental insurance, please bring your ID and insurance card along with any other relevant forms.
Minors must be accompanied by a parent or legal guardian or our Third party consent form will be required prior to the appointment.
Please give us at least 48 hours notice if you are unable to attend your appointment. If you have any questions please don’t hesitate to contact us.

Convenient Locations

Kids2Dentist Delano, CA

FRESNO

452 E Shaw Ave
Fresno, CA 93710

(559) 589-8600

Kids2Dentist Visalia, CA

VISALIA

1814 N Dinuba Blvd
Visalia, CA 93291

(559) 589-8700

Kids2Dentist Porterville, CA

PORTERVILLE

1150 W Henderson Ave
Porterville, CA 93257

(559) 576-2130

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DELANO

815 Cecil Ave
DELANO, CA 93215

(661) 545-7910

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CLOVIS

200 W Shaw Ave
CLOVIS, CA 93612

COMING SOON

LOCATIONS

CORPORATE OFFICE
5449 Hollywood Blvd Suite A
Los Angeles, CA 90027
Phone: (323) 472-4751 Ext 101

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