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Patient Screening Form

This appointment includes an Initial Oral Exam and Panoramic Radiographic X-ray at no cost to you. We evaluate your existing dental conditions and your dental needs. The consultation does not imply an obligation on either party. If your case is eligible, our Dental Specialists will schedule a second appointment, where the doctor explains in detail our program and the reduced costs of your dental treatment. This visit will provide patients the chance of a real diagnostic at no cost and possibilities of treatment at lower costs. In ALL dental cases there will be existing charges for materials and lab fees.

You may request a copy of your x-rays/radiographs, but there is a fixed cost of $150.


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