New Patients

Internet Express Scheduling

For NEW Patients of Bailey Family Dental

If this is an EMERGENCY, please CALL us at 262-369-8633!

New Patient Special!

To acquaint you with our office, mention our website when you call or email us for your exam, X-rays, and professional cleaning, and receive teeth whitening for only $99 per arch, a $200 savings.

Make an appointment for yourself or your entire family today!

Morning, afternoon or evening hours are available.

Please provide the following contact information
Title & First Name:
Last Name & Middle Initial:
Mailing Address:
City:
State/Zip:
Day Phone:
Evening Phone:
E-mail:
Best way to contact:
Best time(s) to contact:
Whom may we thank for referral?:

Questions - Comments

For your convenience, you can print and fill out the required NEW PATIENT’S MEDICAL HISTORY form and bring it to your first appointment.

If this is an EMERGENCY, PLEASE CALL US at: 262-369-8633 ! ! ! ! ! !

Bailey Family Dental
557 Cottonwood Avenue
Hartland, WI 53029
262-369-8633