Copper Canyon Dentistry
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New Patient Forms

For your convenience, we offer our new patient forms online. Please print the following forms, fill them out, and bring them with you to your first appointment. If you have any questions about these forms, please contact our office at (661) 219-7900. Our friendly staff will be happy to assist you.


Appointments and Consultations

If you are a first-time patient, we will ask you to schedule a consultation visit. During your consultation Dr. Hakam Al-Samarrai will perform a comprehensive exam and review your dental and medical histories. Most regular appointments consist of a checkup and professional cleaning. If we notice any protentional instances of decay, damage, or gum disease we may recommend additional treatment. Once we develop an appropriate treatment plan, our front office team will provide you with a detailed list of fees. We can also provide an estimate of out-of-pocket fees based on your insurance policy.