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Routine Exams

Dentures/Veneers

Dental Hygiene

Dental Fillings

Teeth Whitening 

Oral Cancer Screening

Oral Cancer Screening

Extraction

Custom Trays & Guard

Appointment Request

Name (First & Last)

Phone Number 

Email

What day works best for you
What time is best for your schedule?
What kind of appointment is needed?
Are you a patient of record?

Is there anything you would like to share with us regarding your appointment?

Please list any insurance benefits you would like for us to consider. We need 

1. Full Name of Subscriber

2. Date of Birth of Subscriber

3. Member ID# (Could be Social Security Number)

4. Group #

5. Employer

6. Phone number on the back of card

If you feel uncomfortable disclosing any of this information, please give us a call to schedule

What people are saying 

"I think they got this down. Very organized and professional. My hygienist - Carrie -was the best I've had there and there has been some good ones. Very professional and respectful. Awesome job!!"

- Chris S., Google