What's your full name? *

What's your best phone number? *

By checking this box, you agree to receive SMS updates, appointment reminders, and occasional promotions from the company at the phone number I provided. Message frequency may vary. Reply STOP to cancel, HELP for help. Message and data rates may apply. Privacy policy: https://www.mydentistinplano.com/privacy-policy/

What's is your best Email? *

Are you located in Plano, Texas? *

Yes

No

What type of treatment are you interested in? *

General Dentistry (cleanings, fillings, etc.)

Oral Surgery (extractions, wisdom teeth, etc.)

Dental Implants

Cosmetic Dentistry (veneers, crowns, etc.)

Others

Which type of sedation are you interested in? *

Oral Conscious Sedation (pill form)

IV Sedation

Nitrous Oxide (laughing gas)

Not sure – I’d like a recommendation

On a scale of 1–10, how anxious do you feel about dental visits? *

Have you ever avoided treatment because of fear or anxiety? *

Yes

No

Have you experienced sedation dentistry before? If yes, please describe. *

Yes

No

If yes, why?

Preferred time *

Morning

Afternoon

Evening

When would you like to begin treatment? *

As soon as possible

Within 1 month

Within 3–6 months

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