Dental Hygiene Clinic Appointment Reservation

- Appointments are for cleaning and x-rays ONLY!
- Screenings are required for all new patients and patients that haven't visited the clinic in the last 3 years
- We always refer patients to see a general dentist after visiting our clinic
- If you have been to a dentist, please have them send x-rays to DHClinic@tsc.fl.edu
- Appointments can take up to 4 hours long
- Wear warm clothing--temperatures are cold in the clinic
- Allow 72 business hours for a call to be scheduled

Name Name First Last
Date of Birth Date of Birth / MM / DD YYYY
Phone Phone - ### - ### ####
Email
Please Choose One:

Please Choose One: New patient (or if over 3 years since last visit to clinic) Returning patient (within the last 3 years)
When was your last dental cleaning?

When was your last dental cleaning? 2 years or less 3-5 years 5+ years