New Patient Voucher

Let’s Get Acquainted
We want to meet you today!
When you sign up today
you can receive a:

• Free Second Opinion

or

• Free New Patient Dental Exam & X-Rays (cleaning not included)

ACT NOW to receive this offer! Enter your contact information below or directly call us at 319-540-8326 and mention this offer code (Tooth19).

Offer expires 02/22/2020

Patient Forms

New Patient Registration

Certified HIPAA Compliance Provided by PCIHIPAA

For your convenience, you may pre-register with our office by filling out our secure online Patient Registration Form before your initial appointment. After you have completed the form, please mare sure to press the Submit button at the bottom to automatically send us your information.