Dental Web Sites

Request an Appointment

To make an appointment, call us at
(513) 528-0788 during business hours
OR
Please use this e-mail form to request an appointment with us.

Monday: 12 noon to 8:00 pm
Tuesday: 9:00 am to 5:30 pm
Wednesday: 8:30 am to 12:00 Noon (staff)
Thursday: 9:00 am to 5:00 pm
Friday: 9:00 am to 5:00 pm

If you would like to request an appointment, simply complete the form below and we will be in touch with you soon.

Note:  We do not accept CANCELLATIONS via this form.  
If you need to cancel your appointment, please call our office.

First Name:   Last Name:    
Street Address:      
City: State: Zip:
E-Mail:      
 
Daytime Phone:   Cell Phone:  
 
Night Phone:      
   

Are you currently a patient:
Yes
No

How did you hear about us?
Cincinnati Yellow pages
Clermont Yellow Pages
Yellow Book
Internet
Pink Pages
Other
Referred by friend

Preferred dates:    
Preferred times:    
Type of appointment needed :  
Checkup and cleaning
Emergency visit
Cosmetic dentistry consult
Other - specify

                  
 
Please enter code above in the field below.

 
     
New Patients:
You may choose to fill out these forms to save time at your first appointment.

Patient Forms

NOTICE: We cannot guarantee that any e-mail communications are secure. Please understand that this is a risk if you are requesting or sending medical, dental, financial or other confidential information be sent via e-mail. This e-mail is intended to be confidential and personal , intended only for the named recipient(s) above and may contain information that is privileged. The content of this e-mail is not intended to be construed as dental or medical advice and may not be a secure e-mail. If you have received this information in error, or are not the named recipient(s), please immediately notify sender, or our office at 513-528-1150, and delete this e-mail from your computer. Do not send an e-mail in an emergency situation, since an immediate response cannot be expected. Thank you.

 


New Patient Offer

Receive $50.00 off any Cosmetic Dental Procedure

Existing Patient Offer

$50.00 off ZOOM! One Hour Whitening 

Offers Expires:  06/08/2012

Complete the form below to take advantage of either of these offers.


Please enter code above in the field below.

WE USE
HIGH-TECH
DIGITAL
X-RAYS!

Precision, computerized, high quality Kodak x-rays at a fraction of the radiation.

Eastgate Smiles Dental Care · 473 Old State Route 74 · Cincinnati, OH · 45244 · (513) 528-0788
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