new Patient

phone LOG

 

Please fill out  all *  questions

for every new patient call.

 

Full Name of Patient *
Full Name of Patient
Phone *
Phone
We like to share thanks with those who refer patients to Dr. Panahpour. Sharing the name of the doctor, clinic, friend, patient or media outlet that led you to us allows us to show our gratitude to them.
Do you have any Mercury Amalgam/Silver fillings?
Do you have any root canals?
Have you had any wisdom teeth removed?
(IF YES TO ANY OF THE ABOVE) Have you ever had a CT scan or Thermography check for jawbone infection?
Inform patient that in addition to being a world class biological dentist Dr. Panahpour is also the only 100% holistic and biological cosmetic dentist in the state of Washington. If the patient has anything that they would love to change about the look of their smile, Dr. Panahpour can also look at that with them.
FILL OUT BELOW BUT DO NOT ASK PATIENT
Did patient schedule an appointment? *