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If you have a dental EMERGENCY, please call: (562) 804-2296 during office hours.
 Click Here to request a Zoom Appointment     Zoom Information

For all other appointment requests, use below:

   Request an Appointment:

     Please tell us when you would like to come in and we will attempt to place you in your requested time.  Please understand that due to our scheduling policy we may place you elsewhere in our schedule to better service you.  However, we will make every effort to honor your 'e-form appointment request' as a special courtesy.  You will be contacted by our offices to confirm your appointment.  Please call (562) 804-2296 if you would like to be seen today.

               1)  Patient Information:
*Patient's First Name  
*Last Name  
*Home Telephone  
E-mail Address
*Birth date  
Age  
               1b)  Minor Information:
Is patient a child? (under 18) Yes    No
*Name of Responsible Party if under age 18 (eg. parent) First  Last
Responsible Party's Telephone

               2)  Reason for Visit:

Please give a brief reason for wanting to visit us:

               3)  Your Appointment Request:

Requested Location: Cerritos
Lakewood
Requested Date:
Requested Time:
Alternate Date:
Alternate Time:

                                                


Copyright © 1999, 2007 Lakewood Cerritos Dental Centers. All rights reserved.
Revised: August 06, 2007