Our Locations

Appointment Request


Brentwood Braces

Los Angeles Branch
11645 Wilshire Blvd.
Suite 1060
Los Angeles, CA 90025
Phone: (310) 447-5790


Alta Loma Branch
9560 Baseline Road
Suite B
Alta Loma, CA 91701
Phone: (909) 987-7676


Email: contact@brentwoodbraces.com

Children Orthodontics We are excited to meet you. We view your first visit as the initial step in establishing a long and rewarding relationship. It is an important visit because we will take the time to obtain and review important background information, including past dental records and medical history. You will also get a chance to speak with Dr. Firouz to get to know him and to discuss any concerns you may have.

Additionally, we will review your insurance policy to be sure you are covered for our services and help you recover the most from your benefits. We will do our best to help you afford the treatment you need and want. If major care is required, we will design a complete payment plan with an appropriate schedule of payments. Payments to our office can be made in the form of check, cash, or any major credit card.


To set up an appointment or to answer any questions you may have, simply call (310) 447-5790 for our Los Angeles branch, (909) 987-7676 for our Alta Loma branch, or fill out your appointment request here.

Please fill out this form and fax it back to us at 310.447.3867 before your first appointment.


Patient Medical History Form



Is there a specific date that you would prefer?



What day of the week would you like to come-in?



What time do you prefer?



Which office location do you prefer?



Full Name



Phone Number



E-mail Address


Please describe the nature of your appointment


If you are unable to keep an appointment, we ask that you kindly provide us with at least 24 hours notice. A fee may be charged if the patient does not show up for their appointment and sufficient notification is not given. We would like to take this opportunity to thank you for selecting our practice for your dental care and we look forward to meeting you.

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