Patients referred to our practice may not have complex dental requirements but require sedation or anesthesia to deliver dental care. They may have, but not limited to:

  • Anxiety, fear, or phobia of dentistry and its associated sound and/or equipment
  • Young children that are unable to cooperate
  • Difficulty getting numb with local anesthesia
  • Strong gag reflexes
  • Movement disorders, inability to be stationary
  • Physical and Mental disability
  • Extensive dental disease
Patient's Name *
Patient's Name
Patient's Phone Number *
Patient's Phone Number
Referring Dentist *
Referring Dentist
Referring Doctor's Phone *
Referring Doctor's Phone
Services Requested *
Radiographs

Please notify us within 48 hours in advance if you are unable to keep you appointment.