East County Endodontics
Brian E. Hornberger D.D.S.. M.S.
3801 Lone Tree Way
Antioch, CA 94509

Email: info@eastcountyendo.com
Root Canal Hotline
(925) 753-5810
East County Endodontics
Brian E. Hornberger D.D.S.. M.S.
3801 Lone Tree Way
Antioch, CA 94509

Email: info@eastcountyendo.com
Root Canal Hotline
(925) 753-5810
We shall take such good care of you today, that you will hesitate to leave our office for fear of a harsher world outside.

Patient Information

Pre-Schedule Your Appointment

To pre-schedule your appointment, please complete this short form. After you submit your information, you will be taken to a web page with details about what to do next.

* Required
* Patient Name:
* Address:
* Phone:
Other:
Email:
* Birthdate:
(MM/DD/YYYY)
* Social Security #:
(necessary for verifying insurance)
Note: Data in this form is encrypted.

Insurance Information


Primary Subscriber

Dental Insurance Company Name:
Phone #:
Primary Subscriber Name:
Date Of Birth:
Subscriber Social Security/I.D. Number (needed to verify insurance benefits):
Relationship to patient:
(spouse, dependent)

Secondary Subscriber

Dental Insurance Company Name:
Phone #:
Secondary Subscriber Name:
Date Of Birth:
Subscriber Social Security/I.D. Number (needed to verify insurance benefits):
Relationship to patient:
(spouse, dependent)

Symptoms: What brings you to our office?

Is there a crown on the tooth?
Do you have a health condition that requires pre-medicating before dental treatment?
Medication:
Health Condition:
Do you know the tooth number?
If not where is your pain located?



Who referred you to our office?
* General Dentist Name:
Other:
Thank you for pre-scheduling your appointment on-line. One of our team members will contact you shortly to schedule and confirm your appointment.
* Best call back number:

Thank you again, we look forward to seeing you!

Dr. Brian Hornberger
and the Team of East County Endodontics
Serving Contra Costa County, Antioch, Brentwood, Oakley, Discovery Bay, Bethel Isalnd, Pittsburg, Concord,