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OUR STATE-OF-THE-ART
GPS SOLUTION
WILL
TRANSFORM YOUR PATIENT'S SMILE
IN ONE DAY.
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Location
Location
North Orange County
South Orange County
Choose between our 2 Orange County locations.
Dr. Scott Peifer 7891 Talbert Avenue, Suite 101 Huntington Beach, CA 92648 P: (714) 842 2521 F: (714) 842 1083
Drs. Eric Baker, Tim Betita, Ian Lehrer 32241 Crown Valley Pkwy, Suite 220 Dana Point, CA 92629 P: (949) 240 2280 F: (949) 240 2619
Patient Information
Name
First
Last
Phone
Email
Date
MM slash DD slash YYYY
GPS Arch
GPS Arch (Full Arch Implants/ All-on-X)
Double Arch
Upper Arch
Lower Arch
Call before consult?
No
Yes
Would partner DDS like to be present at surgery?
No
Yes
Other Services
Select Service(s)
Single Tooth Implants
Extractions
Wisdom Teeth
Jaw Surgery
Restorative Planning
Intraoral Scan (IOS) Requested
Provide Impression Post and Analog
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