Smiles By Rosie New Patient Request Form
We will be welcoming new patients for regularly scheduled appointments in fall and winter of 2018. We hope to email everyone in the late spring to set up these visits!
We are so grateful for your patience and are doing all that we can to be available to the community without compromising our attentive, soothing, and thorough care. Thanks for bearing with us a little longer!
Please submit your email address below to be contacted when these appointments become available. There is also a question at the end asking about last-minute waitlist availability.
What are some specific dental anxieties, important points about your dental history, or negative past experiences that you'd like to share with us so that we can make your visit as comfortable as possible? This information will be shared with Dr. Rosie.
We have some last-minute new patient appointments that become available on a first-come, first-served basis. We email everyone on this list and request insurance/contact information to assign these appointments. Would you like to receive these offers?
Yes! Email me with first-come, first-served openings!
No thanks! I ONLY want to be emailed in May or June to schedule a fixed appointment time in fall or winter of 2018.
Do Not Fill This Out