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Dr. Egle T. Lesniauskas

11500 West Olympic Blvd, Ste 370 | Los Angeles, CA 90064
Phone: 310-268-1292 | Fax: 310-268-8007

New Patient Forms

For your convenience, you can fill out all of your patient forms electronically prior to your first visit. In addition, you may use these forms to update your information every year before you come to the office.

The forms come in two parts, please complete BOTH FORMS before coming in.

1. New Patient Dental/Health Form - This should be filled out once per child.
New Patient Dental/Health Form

2. New Patient Financial/Insurance Form - This form should be filled out once per household.
New Patient Financial/Insurance Form

3. Make sure your appointment is scheduled with our office and we'll see you there! No need to print your forms out. We will receive them electronically.