New Patient Appreciation

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Thank you for choosing Dental Corner Hawaii as your new dental care provider. As a new patient with no insurance you qualify for our new patient benefit. You will receive teeth cleaning and FREE dental exam and up to 4 x-rays for a total cost of $75.00 + tax. That's a $250.00 value. We appreciate you placing your dental care in our hands.

Contact Information

First Name* Last Name* Email Address* Phone Number* Street Address Apt. / Ste. Number City Zip Code Are you currently experiencing dental problems? Yes No

Appointment Preference

Please tell us which office and what days and times are best for your appointment. You may select more than one day and time.

Preferred Office* Diamond Head
Pearl City

Day Any Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Time Any Time
Early Morning
Mid Morning
Early Afternoon
Late Afternoon

Briefly describe your general reason for requesting an appointment.

Spam Security

Thank you or requesting an appointment with Dental Corner Hawaii. Our scheduling coordinator will call you as soon as possible.

ATTENTION: This form is not active. It is for demonstration purposes only. No information will be sent.