Jeannine Fox, Practice Leader

What would you like to discuss with the dentist during your consultation?

Are you interested in discussing sedation options?

Is there anything in particular that you are concerned about that you want the dentist/hygienist to address? If so, please specify.

I am...

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The best day(s) of the week that I am available are: (click all that apply)

Best time of day for my schedule is:

Do you have dental benefits? *