accessibility ACCESSIBILITY

The first step towards 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.

Financial

Our Financial Coordinators are very good at what they do. We will be more than happy to submit all insurance forms for you. Each patient is provided a thorough treatment plan designed specifically for the individual, so there are no hidden fees. For our patients who may require more attention, a complete payment plan is designed with an appropriate payment schedule that is comfortable for you. We accept most forms of payment including check, cash, and any major credit card. We also offer customizable payment plans through our financing partner CareCredit. (see www.carecredit.com for more information)

Cancellations

We reserve our time in the schedule specifically for you. We ask if you are unable to keep an appointment, that you kindly provide us with at least 48 hours notice if possible. We ask for this advance notice so that we can offer this appointment to another patient who may be able to see us on this short notice. This is our office policy and we may implement a fee to your statement if this notice is not taken into consideration.

We would like to take this opportunity to thank you for choosing Dentila for all your dental needs and look forward to welcoming you to our practice.


Items in bold are required.
Name:  
Address:
City:
State/Province:
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Phone:
Email:
Are you a current patient?
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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.