is a student enrolled in the Dental Assistant Program of Fullerton Dental Assistant School. In order to comply with the requirements set forth by the California Dental Board on placement of pit and fissure sealants, the student needs for you to examine
for placement of sealants.
Please mark all eligible teeth to be sealed on the chart provided below. There needs to be at least one tooth in each quadrant. The instructor will determine which teeth will be sealed in the clinical setting. Thank you for your support in the
Dental Assisting Program.
Dentist Name: Eric Meyer, DDS
Phone Number: (714) 879-7943
Office Address: 2720 N. Harbor Blvd. Suite 110, Fullerton, CA 92835
