At Smile Generation, we recognize that our relationship with you is based on integrity and trust, so we first need to verify your identity. Please complete this form so that we may begin that process. It is critical that all of your information is entered accurately to ensure optimal results.
If you have Power of Attorney, Legal Guardianship, or other adjudication of authority to act in this capacity for another person and are submitting a request on behalf of that person, please send a letter containing the request type(s) e.g. (Request to Know, Delete) together with a copy of your adjudication of authority to:
Compliance & Ethics Department,
Pacific Dental Services,
17000 Red Hill Ave, Irvine,
CA 92614.