NOW SCHEDULING PHONE AND VIDEO APPOINTMENTS TOO!
Due to COVID-19, we will be conducting exams and consultations via video conferencing, whenever possible. You will receive further instructions, if a video conference is necessary. Please call our office for more information. Click here to learn more about how COVID-19 has affected the practice of dentistry in Ohio.
Please fill out this form COMPLETELY. Incomplete forms must be re-submitted. Please list all allergies, medications, vitamins and supplements you are currently taking. If needed, please provide us with a list of your current medication names, dosages and frequencies. Please ensure that this medication list includes your name, date of birth and legal signature.