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Call 214-484-3199 during business hours or please submit the form below to be contacted by a member of our staff:

Parent First Name:
Parent Last Name:
Number of Children to be Scheduled:
Is this your child’s first dental appointment?
Do you have any specific concerns for this visit?
Does your child have any special needs?
Whom can we thank for referring you to our office?
Phone Number:
Mobile:
Email Address:
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