Welcome to Smile Wellness!
Thank you for requesting an appointment. This form helps us understand your child’s needs, goals, and care history so we can prepare a truly personalized visit.

Why we require prepayment and thorough intake:
At Smile Wellness, our approach is different from typical dental offices. From the moment you request an appointment, our team begins preparing for your child’s visit, which may include:

• Gathering medical and dental information
• Coordinating with any therapists or other providers supporting your child
• Reviewing history to design an individualized plan for your consult

Prepayment & Scheduling Policy:

• Full payment is required to reserve your appointment.
• Rescheduling within 5 days of your appointment, or failing to reschedule, will result in a forfeiture of $175 of the visit cost.
• Completing this form does not guarantee a confirmed appointment. Once we review your responses, our team will send a payment link and paperwork to finalize your date.
• Forms should be completed within 72 hours of receiving this link to hold your tentative appointment.

We appreciate your understanding - this ensures that every visit is purposeful, personalized, and prepared in advance, so we can provide the highest level of care for your child.