Phone Call Request

Thank you for your interest in an orthodontic consultation with Dr. Mir. Please complete this form before we see you for your appointment. The information you provide will remain absolutely confidential and it is intended to help us give you or your child the smile you've been waiting for.

Thank you,
York Orthodontics Team

Phone number
Your answer
First & Last name of the patient:
Your answer
Email Address:
We would like to send you an email to confirm your appointment along with instructions for direction and parking.
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