Request Info/Appointment

Thank you for your interest in our services. Please fill out the following form to request more information or to set up an appointment. We will contact you as soon as possible.

You can also send us an e-mail to jbernalv@hotmail.com or give us a call if from the U.S. at 855-755-7571.

Action you want taken: *
Make an appointment Request information about services available
Name *
Phone * - ### - ### ####
Email *
Do you want a price estimate? *
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Type of Dental Work *
Implant Root Canals Root Canal Therapy X-rays Partials Bridgework Mini-implants Surgery Veneers White Fillings Crown Braces ZOOM Bleaching (laser) Bleaching (Take home kit) Extractions Dentures Not on the list
Other work needed, please describe
If an appointment, please give us a preferred date.
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Any other comments?