* = Required Fields Request a Complimentary Consultation Please call me to arrange a no-charge consultation to discuss… General Dentistry (exams/cleanings, fillings, extractions) Cosmetic Dentistry (whitening, veneers, bonding) Dental Implants Restorative Dentistry (crowns, bridges, dentures, partials) TMJ Treatment Sedation Dentistry (oral or IV 'twilight sleep') Gum Disease Treatment Orthodontics (braces, Invisalign, Invisalign Teen) Sleep Apnea Therapy Other Name:*Email Address:*AgeGender Male Female AddressCity, State, ZipPreferred Phone Number to Reach Me:*Preferred Day / Time to Reach Me:I have a current dentist whom I see on a regular basis Yes No I am missing one or more natural teeth Yes No I experience fear or anxiety during dental visits Yes No I am seeking a second opinion Yes No We Look Forward to Welcoming You! 6044 24-Mile Road, Shelby Township, MI 48316 586.739.2155
