College Street Family Dental | Patient Registration Forms in Covina

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Edison Han, DDS, FAGD
Fellow of Academy of General Dentistry

153 West College Street, Covina, CA 91723
Tel: 626-498-2472

Thank you for choosing our office to provide your dental care. We appreciate your trust and look forward to working with you.  

Please print and fill out the registration forms prior to coming in for your first appointment.  Please bring a list of your medications to your appointment.  Do not discontinue any medication that is prescribed by your doctor.

If you have a HMO insurance,  please contact your insurance and verify your eligibility prior to your appointment.  If you are not assigned to our office with your HMO insurance, please contact your insurance and request to be assigned to our office.  If you have any questions, please ask the front desk.

If you have a PPO insurance, please provide us with your insurance information and your birthrday prior to your appointment, so that we can obtain your benefits.

New insurance as well as changes in insurance must be provided to this office prior to an appointment. Failure to provide correct and current insurance information may result in the entire bill being your responsibility.

Contact Us Today To Book Your Appointment!

We look forward to seeing you!

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Please do not submit any Protected Health Information (PHI).