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Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone at 936-544-3790 or complete the appointment request form below. Our scheduling coordinator will contact you to set your appointment.

If you are a new patient to our office, the link below contains our new patient bundle with some of the forms that need to be filled out when you arrive at our office.  Printing the forms, filling them out and bringing them with you will allow us to attend to your first appointment check in more quickly than completing them on your arrival.  Thank you and please contact our office if you have any questions at all.

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

  

Consent for Disclosure Forms

 Health History Forms

 



Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

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