Dental Advanced Dental Appointment

Your Name:*
Age:*
Phone:*
Extension:
Zip Code:*
E-mail:*
* Required Information

-----------------------------------------------------------------------------------------------------

DENTAL WORK

Type of dental procedure needed:

Bridgework	Braces	Bleaching (Whitening)
Cleaning (normal)	Cleaning (deep root)	Cosmetic Dentistry
Crown(s)	Examination	Extraction(s)
Filling(s)	Implant(s)	Pediatric Dentistry
Periodontics (Gum Problems)	Oral Surgery	Root canal therapy
Veneers porcelain
Other:

Additional information:
Please use the space below to let us know what you need to have done.

When do you want your appointment?

(Check One)
Specifically or Generally

Month:

Day:

Time:

Which dentist would you like the appointment with?

Dr. Victor Perez
Dr. Miguel Hurtado
Dra. Patricia Ramirez
No Preference

Payment:
Most dentists in Nogales require payment in by traveler's check, money order or cash ( credit card if available at their office) at the time of service, or in the case of making a prosthesis, 50% of the estimated cost is required in advance.

Dental appointments in Nogales are 40% to 60% less than in the U.S.

If you would like a price estimate for the work you need, please check this box.

Deposit/fee:

~~A $5. service fee is charged by Directory Services.~~ FREE!

A $15 security deposit is required for each confirmed appointment which is credited when you keep your dental appointment or cancel within 24 hours of the time scheduled. FREE! (At least until this free service is abused.)
Please help us by canceling within 24 hours and calling if you are going to be late.

Additional:

We can help if needed:

Find (economical) lodging
Find transportation
Transport you from the Tucson airport if you are flying.
Provide a map right to your dentists door.
Tell us what you need: