New Patient Forms

Please take a minute to fill out the following secure patient forms before your first visit:

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Medical & Dental History - Children

Child Form
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Medical & Dental History - Adults

Adult form
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Photo Release Form

Photo Release
New patient? Special offer here!
Chat with us
Welcome to Ultra Smiles!
We look forward to going beyond your expectations!
How can we help?
I'm considering treatment
I’m a patient and need assistance
That's great news!
We're now offering complimentary Virtual and In-Office Consultations
PLUS, we have a special offer for you.
By chatting here we’re both saving valuable time, so you've just earned a $250 credit toward treatment!
Use this promo code: SMILE and click one of the options below here to redeem your $250 credit and let us know what you are comfortable doing next:
I'd like to set up a virtual consultation
I'd like to set up an in-person consultation
I have a quick question - click to call Ultra Smiles