Schedule a new exam

Online booking for a new patient exam.

This form is for a new patient


Preferred appointment time:

What is the name of the doctor who referred you to our office?:

Reason for the consultation, please check all that apply:
  •  Dental implants
  •  Gum disease
  •  Gum recession / Gum grafting
  •  Crown lengthening
  •  Other Please specify below
  • other:

First Name (required):

Last Name (required):

Email (required):

Phone (required):

Address (required):

City (required):

State (required):

Zip code (required):


Please enter text :captcha


Jack Wasserstein, DDS