Request An Electronic Consultation
 
Please fill out the Electronic Consultation Form below. If you would like us to make an appointment for other family members, please list the names on the message area.
By submitting this form for a Teledentistry consultation with our Dentist, you understand that you are agreeing to have the doctor preliminary diagnosis the issue.  You are also agreeing to a consulting fee of $79.00 for an after hours call which is equal to a limited exam, however is NOT REMIBURSABLE by your insurance company.  Any pictures attached may also have a $15.00 processing fees in addition to the Teledentistry fee.
Upload or drag files here