Schedule an Appointment

IF THIS IS A MEDICAL EMERGENCY, PLEASE CALL 911

New Patient Form

All new patients are required to fill out a “New Patient” form when visiting Clear Lake Dental. Feel free to print and fill out the “New Patient” form before your visit for quicker registration.

New Patient Form
Hours of Operation

Monday: 8:00 a.m.–5:00 p.m.
Tuesday: 7:00 a.m.–3:00 p.m.
Wednesday: 8:00 a.m-5:00 p.m.
Thursday: 7:00 a.m.–3:00 p.m.
Friday: 8:00 a.m.–1:00 p.m
(Closed every other Friday)
Saturday: CLOSED
Sunday: CLOSED

Complete the form below and then click on the “Submit Appointment Request” button.

PATIENT INFORMATION

Name *

Email Address *

Telephone Number *

Brief reason for appointment *