NEW PATIENT REQUEST FORM

If your child is, or maybe be, experiencing a dental emergency –
please call us immediately and speak with one of our on-call dentists: 970.224.3600

Fill out the form below to request a new patient appointment at Mountain Kids Pediatric Dentistry. After you’ve completed the form, someone will reach out to you either via text or phone call the next business day or sooner.

You’re always welcome to give us a call to schedule your appointment directly at 970.224.3600.

 

What day of the week is best (Select all that apply)
What time of day is best (Please select one)
Would you prefer a text or phone call? *