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1

Is this booking for multiple people?* This field is required.Choose "yes" if you're trying to coordinate a visit for multiple people (like a family)!

Yes

No

2

Is the client(s) under 18?* This field is required.

Yes

No

3

Name of Guardian

First Name

Last Name

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...

5

Please tell us your name.* This field is required.

First Name

Last Name

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

7

What is the best contact method?* This field is required.

Call

Text

Email

8

Phone Number* This field is required.

9

Email

example@example.com

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)

11

Is there anything else you'd like us to know ahead of time?