Patient Forms

We are a paperless office and offer all of our patient forms online.

Please go ahead and read the following documents, we will sign them electronically when you arrive for your first appointment.

Consent for Dental Treatment

HIPAA-Notice of Privacy Practices

Dental Material Fact Sheet

If you would like to fill out that patient registration form, please feel free to email it to us at info@drhouri.com, you can find the registration form here.

Registration Form

* Required

Patient Registration













Insurance Information












Insurance Information





Medical History

Although dental personnel primarily treat the area in and around your mouth, your mouth is a part of your entire body. Health problems that you may have, or medication that you may be taking, could have an important interrelationship with the dentistry you will receive. Thank you for answering the following questions.

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Aspirin
Penicillin
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Local AnestheDcs
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Does your child have, or has had, any of the following?


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Schedule a dental exam

Nearly 50% of children will have at least one cavity by age 5.

Schedule here

Read Testimonials

Read what Dr.Houri's patients have to say about their child's experience.

Read here

Opening Hours

  • Tuesday - Friday 8:30am - 5:00pm
  • Saturday and SundayClosed

Testimonials

"My oldest son was not as cooperative with prior dental care providers. Everyone that works there is genuine, professional and kind. We REALLY appreciate seeing the same happy faces every time." Nicole P, Vista, CA