• New Patient Offer

    All New Patients receive a FREE Sonicare EasyClean® ($89.99 Value) or Sonicare For Kids® ($69.99 Value) rechargeable toothbrush upon completion of their new patient exam, films, and cleaning.

    Complete the form below or call our office to take advantage of this offer!


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Cosmetic Analysis

For a cosmetic analysis, simply complete the form below and someone from our dental team will contact you soon.


What do you have concerns about? (please check all that apply)

Back Teeth
Color of Teeth
Discolored Restorations (i.e. existing crowns, fillings, bonding)
Front Teeth
Gaps or Spaces between Teeth
Position of Teeth (crooked or crowded)
Shape of Teeth
Show too much Gum
Size of Teeth
Symmetry of Teeth
Teeth Chipped or Broken
Inflamed or Bleeding Gums



What do you like best about your smile?

What do you like least about your smile?

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Comments or Questions:



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"Dear Dr. Smith and Staff,
Thanks to your treatment coordinator for dealing with insurance and getting results. Thank you to your dental assistant for being the ultimate cheerleader and keeping me up and a believer. Finally, Dr. Smith thanks for understanding my years of dental fears and giving me a perfect, absolutely beautiful set of dentures that I love with zero adjustments needed. I’m eating lettuce, apples, nuts, carrots, all the crunchy foods I love! Thank you so much."
Kathy K.

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