New Patient Forms

You can complete your patient registration online any time before your appointment by clicking below: 

New Patient Adult Registration

New Patient Child Registration

If you prefer to complete your patient registration in our office, please arrive 15 minutes prior to your appointment time. 

Our Office


Pan Pacific Dentistry- Ray Pan, DDS, 227 West Badillo St. Suite #1,
Covina, CA 91723
Get Directions

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.