Welcome to Our Office

Thank you for selecting Dr. Banta’s office for your dental needs. We sincerely hope you find a noticeable difference here in our personalized and caring treatment of our patients. 

Your first visit will be a complete examination, which includes X-rays and possibly intro-oral photos, complete head and neck examination, and prophylaxis.

We will be taking time with you to discuss your dental needs and goals. Our goal is to provide you with the best care possible. 

Please complete the below Health and Information Questionnaire, and bring your insurance information and current X-rays if you have them. If your X-rays are from another dental office, we would be happy to assist you in obtaining them. 

Sincerely yours,

Dr. Banta & Staff

Forms

Every new patient is required to complete the New Patient Health History Form. You can download, print, and bring a completed physical copy with you to your appointment by clicking the link below. 

If you would prefer, you may also complete the form online below. 

New Patient Health History Form

Step 1 of 7 - Patient Section

  • Patient Section

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY

Book an Appointment

Hours

Get in Touch

4900 Edinger Ave
Huntington Beach, CA 92649

Phone: (714) 846-4411

Email: gildacbanta@gmail.com

Call Now ButtonSchedule Appointment