New Patients - Request an Appointment

Call For An Appointment Now! (920) 682-9131

Or, you can simply provide us with the following information and we will contact you shortly to schedule an appointment.

We're looking forward to meeting you.

If this is a dental emergency, please call (920) 682-9131 or dial 911.

*Title: Mrs. Mr. Ms.

*First name:

Middle initial:

*Last name:

I like to be called: (Sample: Mrs. Jones or Jennie)

*Address 1:

Address 2:

*City:

*State/Province:

*ZIP/Postal Code:

*Email:

Work or cell phone:

*Home phone:

Fax:

I prefer: Smile Clinic, S.C.

Call me: at either phone at home at work or cell

The best time is:

*How did you hear about us: Choose One 1stDDS.com Doctor's Email Newsletter Smile Card Referral Yellow Page Ad Direct Mail Friend / Word of Mouth Former Patient Internet Search Directories

Referred by:

Do you have an immediate concern?

Would you like to subscribe to our newsletter?

 

Our email policy - We promise never to sell, barter or rent your email address to any unauthorized party.

Financial Arrangements

Our goal is not to let expense prevent you from benefiting from the quality of care you desire and need.