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Get In Touch

Whether you’re scheduling or following up on an appointment, have questions about our office, or just want to say hi — we want to hear from you! Send us a message or give us a call to speak to one of our compassionate team members. We look forward to connecting with you soon!

For Dentists

Dentist Referral

Dental Care Provider
Patient Information
Is Patient 18 years of age or older?*
if not, please provide the following information
*Please do not submit any Protected Health Information (PHI).
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Dental Care Clearance

Dental Care Provider
Any Decay?
If yes, has all decay been restored?
Are perio findings consistent with good oral health?
Is this patient cleared to begin Orthodontic treatment?
*Please do not submit any Protected Health Information (PHI).
Thank you! Your submission has been received!
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