Referral Form

If you are a referring doctor, please contact our office about the process of referring your patient to our endodontists in Glendale, California. Dr. David Abdelmalak gladly welcome referred patients, and we will help you through the process.

Online Forms are only available through the Google Chrome web-browser. (mobile version not supported)
Click here to download Google Chrome.

Online Forms (Submit Online)

New Patient Form
Health History Form
HIPPA Form
Referral Card

CBCT Kodak 9000

We use this state-of-the-art imaging system in our office to access a clear, complete, and accurate picture of your entire mouth.


Same-Day Emergencies

We understand emergencies can come out of nowhere, which is why we are committed to caring for your needs the same day!