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 request an appointment
To request appointment availability, please fill out the form below.
We will contact you to confirm your appointment.
Is there a specific date that you would prefer?
,
If not, what day of the week would you like to come in?
What time do you prefer?
Your full name:
Your e-mail address:
Your phone number:
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Please describe the nature of your appointment:
Please enter the following code for avoiding spams *:
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Download parent forms
A Smile 4U is designed just for children and provides an environment that is inviting and soothing. However, we understand that a child’s first dental visit can be a little unsettling.
We will make every effort to ensure that you child’s appointment is an enjoyable experience.
For your convenience, feel free to print and fill out the patient forms to expedite your sign in process:
 Patient information form (english)
Patient information form (spanish)
PC General dentistry for children consent for use and
disclosure of health information form (english and spanish)
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