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Glendale, AZ 85306

Call Us Today 623-792-5794 | FAX: 623-792-5809

Online New Patient Form

Save time at your first appointment by downloading and completing the new patient form. You do NOT need to print this form and bring with you. Once the form is complete click “submit” and this form will be sent to us. This information is required for all new patients including those referred by their primary dentist. If you are unable to complete the form prior to your visit, please arrive at your appointment 10 minutes early to provide the required information.



If this is not convenient for you, please allow an extra 10 minutes before your appointment to complete the form in the office.

AT (623) 792-5794

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