APPOINTMENT REQUEST
The first step to a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.

*Items in bold are required.

 Please print, fill out and bring the following three forms to your first appointment:

___________

1 New Patient Registration & Medical History

2 Consent to use Medical Information

3 Office Policies Form

Records Release:

Records Release Form

(New Patients: Fill out and send
this form to your previous dentists
to have your records sent to us.)

Record Release Form

(Current Patients: Fill out and
send this form to us to have your
records sent to a new Dentist.)

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.