We Welcome All New Patients!

Dr. Angelina Yap and her dental team look forward to having you visit us as our patient. If you would like to request an appointment, please take a minute to fill out the form and its required information below to make an Appointment Request.

Request an Appointment

Fill out the form below and we will contact you during our working hours.

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    Patient and Contact Information








    Dental Insurance


    Dental Insurance Information




    Note: All names must be exactly as shown on insurance card.







    Requested Dental Service


    Dental Emergency / Urgent Problem


    Dental History


    Additional Information

    Cancellation Policy

    We kindly request all patients call or email at least 48 hours prior to your appointment time if you wish to cancel or reschedule. If you do not call or email within 48 hours of your appointment, you will be charged $25. If you no-show or cancel within 24 hours of your scheduled appointment you will be charged $50. The fee is necessary as we cannot fill the appointment in such short notice. If you cancel or no-show too many times, we may require a nonrefundable deposit to schedule your next appointment.

    Business Hours:

    9:00 am to 6:00 pm

    9:00 am to 6:00 pm

    8:00 am to 5:00 pm

    11:00 am to 2:00 pm

    8:00 am to 5:00 pm

    9:00 am to 3:00 pm

    Closed

    We will return your request as soon as possible during business hours or within 24 to 48 hours after hours.

    Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information. Please review our privacy policy and website terms of use before submitting your form request.

    Thank you from everyone at Pure Smiles DDS for visiting our website!