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Please fill out the form below and we will contact you with an appointment time. Required fields are marked with asterisks (*).

Patient Information

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What is the reason for the appointment? *

  Regular Exam / Cleaning
  Specific Concern / Procedure

Please note that for New Patients we do not schedule a cleaning the same day as the initial exam. We are happy to bill most insurances, if you have questions about whether we are in network or not, please give us a call. We are unable to bill OHP.

If we have not seen you before, please answer the following questions:

Do you have Dental Anxiety? *

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Have you used sedation in the past? *

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What have you used for sedation in the past and did it work?

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