Wellness Form

Name *

First

Middle

Last

Phone

Do you have cough? *

Do you have fever now or in the past 14-21 days? *

Have you come in contact with any confirmed COVID-19 positive patients in the last 14 days? *

Are you experiencing shortness of breath or difficulty breathing? *

Have you experienced recent loss of taste or smell? *

Are you over the age of 60? *

Do you have heart disease, lung disease, kidney disease, diabetes, or any auto-immune disorders? *

Have you traveled to any region affected by COVID-19 in the past 14 days? (As relevant to your location) *

Phone

Ahmed AlSabri ★★★★★ 10 months ago
Dentist Always confident, frank and creative, a genius with dignity and his group too
Mahvish Ponce ★★★★★ 2 years ago
The best dental clinic ever. The staff are good and . Dr Ali is super nice, very knowledgeable and very gentle. I strongly … More recommend Dr. Ali to anyone who has any kind of dental issues. Looking forward to having my tooth implant in a couple of months.
Wendy Chan ★★★★★ a year ago
I have been seeing Dr. Mohamed Ali for 6 years now. He has given me excellent care and masterful service, a beautiful smile … More with nice Hollywood teeth. In addition, he has excellent bedside manners. His office staff is awesome and Cherry is very talented in finding ways to maximize my dental insurance. Husna does an amazing job in cleaning my teeth. I am always leaving the his dental office with a big smile on my face. Plus the location is perfect and the 1929 architecture of the medical building is beautiful.