Online Forms
Save time by securely filling out your forms before you arrive.
1. New Patient Registration
Please complete our secure online New Patient Registration form. After you have completed the form, press the Complete and Send button at the bottom to automatically send us your information.
2. Records Release Form
Please complete our secure online Records Release Form. After you have completed the form, press the Complete and Send button at the bottom to automatically send us your information.
3. HIPPA POLICY AND ELECTRONIC COMMUNICATION AUTHORIZATION
Please review our Privacy Policy and complete our Electronic Communication Authorization form. After you have completed the form, press the Complete and Send button at the bottom to automatically send us your information.
We are committed to protecting your medical privacy. We do our best to ensure your information is protected and secure.
Get in Touch
Want to have the smile you’ve always dreamed about? Let us help.
Appointment request in Souderton
Appointment request in Harleysville
You can now text our team during office hours.
Text Us – SoudertonLOCATIONS & HOURS
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Souderton Location
775 Route 113, Souderton, PA 18964 - Call for Appointment: 215-486-1649
Mon, Tues: 8:00 a.m. to 8:00 p.m.
Wed: 7:30 a.m. to 6:00 p.m. Thurs: 7:30 a.m. to 8:00 p.m.
Fri: 7:30 a.m. to 4:00 p.m.
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Harleysville Location
181 Main St, Harleysville, PA 19438 - Call for Appointment: 215-486-1652
Mon: 7:30 a.m. to 6:00 p.m.
Tues: 7:30 a.m. to 5:00 p.m.
Wed: 8:00 a.m. to 8:00 p.m.
Thurs: 8:00 a.m. to 5:00 p.m.
Fri: 7:30 a.m. to 4:00 p.m.
