Visit our Costa Mesa, CA dental office!

Here at the dental office of Katherine Harrell, DMD we like to make things as smooth for you as possible. That is why we have included all the forms you need for your visit with us below. Filling them out and bringing them in with you for your visit ensures that you will have a quick check-in. If you have any questions about the material supplied below we will be happy to answer your questions!

 

Forms to Print, Fill Out and Bring to your appointment:

 

Patient Questionnaire

 

Notice of Privacy Practice Acknowledgement

 

The Facts About Fillings Acknowledgement Form

 

Informational Material- Please read

 

Notice of Privacy Practice

 

The Facts About Fillings 

 

Appointment request

Need an appointment with a dentist in Costa Mesa ? Requesting an appointment at our Costa Mesa, CA family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with us today!
Patient Name*
Phone Number*
Email Address
Are you a current patient?
Best time(s) to call?
Preferred Appt Date
Preferred Appt Time
Message
Describe the nature of your appointment or any other comments