Request an Appointment Appointment Parent/Guardian Name * Parent/Guardian Name First First Last Last Your Phone Number * Your Email * Which office would you like to us to find you an appointment? Dominion Crossing Downtown Northeast (Village Drive) Northern Oaks Schertz Southcross No preference Our office locations What time of day would you like your appointment? * Morning (8:30 am – 11:00 am) Middle of Day (11:00 am – 1:00 pm) Afternoon (1:00 pm – 2:30 pm) No preference Which days work best for you? Monday Tuesday Wednesday Thursday Friday Patient Information Name * Name First First Last Last Date of Birth * Is this the first time we have seen this patient? No Yes Dental Concerns Regular check-up / cleaning Possible cavities Lip and/or tongue tie evaluation Invisalign evaluation Second opinion Add Additional Patient Remove Patient Is there anything else you would like us to know? Upload photo of your insurance card (optional) Drop a file here or click to upload Choose File Maximum upload size: 516MB If you are human, leave this field blank. Submit Δ
