Request edit access
Request an INITIAL appointment
Please complete the following information. Our forms are HIPAA-compliant. All information is considered to be sensitive and important and will not, under any circumstances, be sold or distributed without your express, written permission.
A member of our team will contact you to discuss you concerns. Please allow 10-15 minutes for the phone call as we would like to fully understand your reasons for becoming a patient. This information will be shared with our doctors prior to your initial evaluation.
Patient Name (First and Last)
Your Name (First and Last)
Preferred Contact #
Would you like for us to contact your dentist prior to your initial evaluation with our doctors?
Tell us a little about your concerns.
What time would you like for us to call you?
Which of our locations best fits your needs?
Athens at 600 Oglethorpe Ave., Suite 3
Watkinsville at 1020 Jamestown Blvd, #100
Send me a copy of my responses.
Please complete the captcha before submitting the form.
Never submit passwords through Google Forms.
This form was created inside of Classic City Orthodontics, PC.
Terms of Service