(614) 475-5439

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Comprehensive Smile Care Myofunctional Therapy Sleep Apnea Solutions Lip & Tongue Tie Treatment Anxiety, Autism, & Special Needs HLS Smile Plan

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7:30am - 4:30pm

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location

5770 n. hamilton rd. suite a
columbus, oh 43230

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5770 N. hamilton rd. suite a
Columbus, oH 43230

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Request An Appointment

Please call (614) 475-5439 or use the form below to schedule your appointment.

Name:Phone Number:Email Address:Preferred Dates & Times:Message:

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Referral form

Patient Name:

Patient Phone Number:

Patient Date of Birth

Referring Doctor:

Referring Telephone:

Radiographs:

MailedGiven to PatientPlease Take

Reasons for Consultation:

IV SedationGeneral Anesthesia

Please check the teeth to be treated:

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910111213141516

3231302928272625

2423222120191817

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Thank you! Your request has been received. We will call or email you to confirm your appointment date and time. To speak with someone right away, please call our office.

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