New Patient Form

Thank you for choosing Special Smiles. We look forward to meeting you and your child. Please take a moment to complete our new patient form below prior to your scheduled visit to ensure we have the appropriate information for our records. Please contact us with any questions about your upcoming visit or this form. A member of our Special Smiles staff would be happy to assist you. 

Please know that the information you provide will remain confidential and this online form is secure.