Name: *
Date of Birth
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Phone: *
Email address: *
Dental Insurance Company:
Have you visited our office before? *
How did you hear about Sweet Tooth Family Dental?
What is the reason for the appointment? *We are not scheduling urgent care for non-established patients at this time *
New patient appointment to establish careEstablished patient exam/cleaningProcedure/Specific Concern (established patients only)
Please indicate what would be a good day and time for your appointment? Leave blank if you would like our first available options. Our hours are Tues, Wed, Thurs & Fri from 7:00am - 3:00pm
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