About Our Clinic
UCLA Special Patient Care Clinic within the School of Dentistry specializes in treating patients with special healthcare needs and medical complexities. All new patients attend a screening appointment to see if we are the appropriate dental home for you and how we can best serve you and your needs. 

Instructions
By filling out this form you are asking to be placed on the waitlist to become a new patient in our clinic. If you have a referral from your doctor, please have it ready to upload into this form.

Waiting List
We will schedule your screening appointment when it is your turn on the waitlist. We are currently scheduling new patient screening appointments 18 to 24 months from now. Please note no dental treatment is provided at this first visit.

We complete 2,000 appointments annually and do the best we can to ensure all the patients we see are provided quality and compassionate care. We thank you for your patience!

Questions
If you have any questions or need assistance with completing this form please contact our social work team at (310) 206-6670. Social work is available most Mondays, Wednesdays, and Fridays. 

• This form is HIPAA compliant
• Submitting this form does not automatically make you a patient of our clinic