At GentleCare Dentistry - it’s all about you! Everything we do is done with your health, comfort and convenience in mind. To request appointment availability, please fill out the form below. Our scheduling coordinator will contact you to confirm your appointment.

Please click here if you wish to print New Patient Application.

Are you a current patient?
First Name:
Last Name:
Address:
State:
Zip Code:
Phone Number: ( ) -
Email:
Referred By:
Preferred day of the week?
Preferred time?

Please describe the nature of your visit (e.g., Check-Up, Toothache, Cosmetic, etc):