Fill out this form to enter!

Name *
Name
Phone *
Phone
Current needs/interests *
Please feel free to tell us anything you would like us to know about you, your past dental experiences, goals regarding your oral health, etc.

TERMS: To view the details of our membership plan, please see our financial section here. You do not have to be a patient to enter. Prizes must be picked up or redeemed in person at our office.

*Annual routine care is based on patients who do not need periodontal treatment for "gum disease." Status is determined at first visit.