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Meet Dr. Goldwyn
Look Book
All On X
Specialized Treatments
Medical and Dental Insurance Accepted
Dental Research
Contact the Doctor
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Dave Goldwyn Jequinto, DDS, FICOI
Caring and Comprehensive Dentistry. California | Texas | Washington
Home
Meet Dr. Goldwyn
Look Book
All On X
Specialized Treatments
Medical and Dental Insurance Accepted
Dental Research
Contact the Doctor
PATIENT NAME
*
First Name
Last Name
MOBILE PHONE
*
A smart phone such as an Apple iPhone or Android is required.
(###)
###
####
EMAIL ADDRESS:
*
What type of orthodontic treatment are you currently undergoing?
*
Invisalign
Traditional Braces
Hybrid - Invisalign + Braces
I'm in retainers
INVISALIGN PATIENTS ONLY: What number aligner are you currently wearing? How long have you been wearing this aligner? If you are awaiting your first set or waiting for additional aligners, let us know.
INVISALIGN PATIENTS ONLY: Do you currently have attachments/buttons on your teeth?
YES
NO
INVISALIGN PATIENTS ONLY: Are you currently scanning and on Dental Monitoring?
YES
NO
TRADITIONAL & INVISALIGN PATIENTS: Please let us know your questions or concerns.
TRADITIONAL BRACES PATIENTS ONLY: Are you currently wearing elastics?
YES
NO
Thank you! You are cleared to schedule your virtual appointment!