New Patient Form - Adult

New patient? Special offer here!
Chat with us
Welcome to Ultra Smiles!
We look forward to going beyond your expectations!
How can we help?
I'm considering treatment
I’m a patient and need assistance
That's great news!
We're now offering complimentary Virtual and In-Office Consultations
PLUS, we have a special offer for you.
By chatting here we’re both saving valuable time, so you've just earned a $250 credit toward treatment!
Use this promo code: SMILE and click one of the options below here to redeem your $250 credit and let us know what you are comfortable doing next:
I'd like to set up a virtual consultation
I'd like to set up an in-person consultation
I have a quick question - click to call Ultra Smiles