Have you been a patient at Bright Smiles before?  New Patient Existing Patient

Patient's First Name: (required)

Patient's Last Name: (required)

Responsible Party (if not patient):

Email (required)

Phone Number (required)

1st Choice Appointment Date:

1st Choice Appointment Time:

2nd Choice Appointment Date:

2nd Choice Appointment Time:

Are you currently experiencing any dental problems?  yes no

Include any additional information if necissary

This information is transmitted safely and securely protected for your confidentiality.

We understand your first visit to a new dentist can be stressful. Follow the link to find a summary of what to expect as a new patient to our office. First Time Appointments

You’re coming to Bright Smiles Dental because you want to see a dentist, not be handed a clipboard. Make it easy and download our patient forms now. Download Patient Forms