GK Dental ~ Elder Health Group
Exceptional Dental care for the Elderly in Assisted and Memory Care communities
Full Name of RESIDENT
First Name
Last Name
Please enter the EMAIL ADDRESS that we have on file for the person paying below
example@example.com
Do you already have a Date/Time for an upcoming Dental Appointment with us?
YES
NO
Dental Care Payment (using Mobile Dental Office)
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Comprehensive Dental Exam & Full X-rays
$
362.00
Prophylaxis - Dental Cleaning in MDO
$
214.00
Credit Card
Submit
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