Telephone972-393-9779
Melissa Rozas, D.D.S.
Dentistry for Infants, Children and Teens, P.A.


Appointments

Schedule Your Visit With Us

Use the form below to request an appointment with our office. Once completed, a member of our team will be in touch within two business days.

View Our Patient Forms
View Our Patient Forms
Request an Appointment
Request an Appointment

Your Information

First and Last Name:


Street Address:

Apt #:

City:

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Work Phone:

Home Phone:



Patient Information

Patient Name:

Age:

Gender:



Appointment Information

Preferred Appointment Date:

MM/DD/YY

Choose a Time:

If this date is not available, choose a preferred day of the week
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Reason for Appointment:


Children in pre-school and elementary grades are usually seen in the morning. Late afternoon appointments are reserved for middle and high school age patients.



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