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Call us(760) 323-2771 or e-mail

New Patient Form – Jay Jorgensen, DDS

New Patient Forms

Please download, fill out this form and then print it. Bring the printed form with you to your fist appointment.

PDF Attachment Icon

Welcome letter and new patient forms


Click on the icon above. IF it opens in your browser then please fill it out and then print it.

If it downloads, then open the PDF, fill it out and then print it.

Sign the various pages and bring them with you to your first appointment.