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
How did you hear about us?
Send me a copy of my responses.
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