Patient Forms & Accounts

New Patient Forms
Enter Patient Information and Medical & Dental History here.
Your Online Account
Create or login to your PATIENT ACCOUNT to 
Pay a bill
Update your personal information
Update your medical & dental history
(It may take one business day for your account to be created and your information updated.)
A 5% discount is given for payment in full at time of service.
We accept MasterCard and Visa.
Payment Plans are available through Care Credit.
To make a Care Credit payment online, click Pay Now button. 
Notice of Privacy Practices
The privacy of your health information is important to us. Read our Notice of Privacy Practices.

Appointment request

Need an appointment with a dentist in Cassville ? Requesting an appointment at our Cassville, WI family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with us today!
Patient Name*
Phone Number*
Email Address
Are you a current patient?
Best time(s) to call?
Preferred Appt Date
Preferred Appt Time
Describe the nature of your appointment or any other comments