WilshireSmiles.com

  Request an Appointment with Dr. Asher, DDS, MAGD

Specific Concerns
Check Up / Cleaning
Crowns
Whitening
Veneers
Lost Filling / Lost Crown
Bridges
Chipped / Cracked Tooth
Tooth Implants
Night-Guard or Splint
Anti-Snoring Devices
PerioProtect
    
 
 
Oral Pain
Location
None        
Upper Left
Upper Front
Upper Right
Lower Left
Lower Front
Lower Right
TMJ - Temporomandibular Joint
Other:
Discomfort Information
Sensitivities
Description
Warm Temperatures
Sharp Pain
Cool Temperatures
Dull, Throbing Pain
Pressure (e.g. Chewing)
Bleeding
 
Your Information
New Patient
Existing Patient
Your Name:
Phone Number (opt.):
Email Address:
   
Scheduling Preferences
Time of Day:
 
Day of the Week:
 
Time Frame:
 
 
   
 
   
 

© 2009 Dr. Stephen Asher, DDS, MAGD | 2901 Wilshire Blvd, Suite 205, Santa Monica, CA 90403 | Dental Website Design

Dr. Stephen Asher, DDS, MAGD is a Santa Monica General Dentist and Cosmetic Dentist. Dr. Asher performs
dental services including prophylaxsis (regular cleanings), teeth whitening, night guards, crowns, TMJ
Disorder solutions, and veneers through gentle dentistry techniques.

  
Santa Monica Dentist