Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment. (*Please note: we are terminating our Aetna participation as of 11/1/2021. Also, we are not taking any more Cigna members at this time.)

  • We will respond to your request as soon as possible during our regular business hours.
  • Our hours: Monday 9am - 5pm Tuesday/Wednesday 7am - 5pm Thursday 7am - 4pm Friday 7am - 12pm Closed on weekends
  • Please select your dental insurance carrier from the options above: (Please note, we do not accept state insurance at this time)
  • Please input your individual subscriber ID - not the group number
  • Input the date of birth of the insurance policy holder.
  • This field is for validation purposes and should be left unchanged.