Please fill out the form below. We will contact you as soon as possible.
Returning or New patientReturning patientNew patient
When you have a specific concern and you want to have Dr. Bautista’s opinion, this is the perfect appointment for you.
What to expect:
Your Name (required)
Your Email (required)
Your Phone Number (required)
Please select which service you’re interested in.
Select the serviceRegular Cleaning (Hygiene Therapy)EmergencyTreatment pending
Details about your emergency
Select LocationLower rightLower leftTop rightTop leftLower both sidesTop both sidesUpper frontLower front
Select IntensityNone1 out of 102 out of 103 out of 104 out of 105 out of 106 out of 107 out of 108 out of 109 out of 1010 out of 10
Kind of pain
Select kind of painDullSharpSpontaneousn/a
Tell us some details:
When would you like to come?