Please review the information below. If everything is correct, click “Send”. To go back and edit your entries, click “Edit”.
Error: The following required items were not provided or are in the wrong format. Please provide the required responses and submit again:
This is the number we will use to contact you if you are selected for an appointment.
Please select the date of your most recent dental cleaning. If you are unsure, please approximate as closely as possible.
Time Commitment
Please be prepared to commit to as many four-hour appointments as your care requires. Every step of the process is checked by a dentist or instructor, so patients typically require one to five visits.
Availability
The fall semester runs from mid-August through mid-December. The spring semester runs from mid-January through mid-May. Select the days/times you are generally available (required):