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Patient Information:

Patient Type:*

Patient's Name & Date of Birth:*

Appointment Information:

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Your Contact Information:

Your Name:*

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Your Relationship to the Child(ren):*

Email:*

Phone:*

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By agreeing to these terms and conditions you agree to receive automated marketing and informational SMS text messages from Sandia Pediatric Dentistry. These messages may include appointment reminders, payment reminders, and other information related to your account or services with us. The frequency of these messages will vary depending on the purpose but in no case will you receive more than 5 per month. Reply HELP for support. Reply STOP to opt out. Standard message and data rates may apply. You acknowledge that you have read and understood our Terms and Conditions and Privacy Policy.

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