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1
Is this booking for multiple people?
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Choose "yes" if you're trying to coordinate a visit for multiple people (like a family)!
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2
Is the client(s) under 18?
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3
Name of Guardian
First Name
Last Name
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4
Please tell us the names of all people included in your booking!
If under 18, please include age so we can adjust appointment times...
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5
Please tell us your name.
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First Name
Last Name
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6
Which service would you like to book?
complimentary 30 minute consult
a dental cleaning
a dental cleaning + 20 minute whitening treatment
Deluxe In-Office Whitening - $400
Express In-Office Whitening - $300
In-Office/Take-Home Combo - $250
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7
What is the best contact method?
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Call
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Email
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8
Phone Number
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9
Email
example@example.com
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10
What time(s)/date(s) work best?
Appointment start times: Closed on Mondays.Tuesdays + Thursdays (9am-6:30pm), Wednesday's (10am-6:30pm), Fridays (10am-2:30pm)
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11
Is there anything else you'd like us to know ahead of time?
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