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Professional Referral

Professional Referral

If applicable
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Main Concern *
Dental Clearance *
Does the patient have any dental work that would prevent the start of orthodontic treatment?

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The first step toward achieving a beautiful, healthy smile is to schedule a consultation. To schedule a consultation, please complete and submit the request form below.

Our scheduling coordinator will contact you soon to confirm your appointment. Please note this form is for requesting a consultation. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly.

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