Client Registration:

registration desk
client registration form

Registration Form for New Clients:

If you would like to become a patient under our care but feel pressed for time or might want to take your time completing our new patient registration form at your leasure, then you may download the form ahead of time here.

Please print the form, fill it out and bring it with you or send it to us electronically.

You can email the form to us: click to send email

Or send it by mail to our office:
Dr. Alexander Vasserman DDS
Valencia Medial Center
25880 Tournament Road / Suite 213
Valencia, CA 91355

Copies of the form are available at our office as well.