5

Experience a Virtual Consultation

Call Us: (480) 991-2290Call Now For An Appointment

Contact Us

Patient Name*
First Last
Email*
Daytime Phone*
Alternative Phone
I am Interested In
I am Interested In
- Regular Appointment
- Virtual Appointment
- Other
Preferred Days*
Time*

: HH

MM
How did you hear about our practice?
How did you find our website?
Tell us about your dental needs*
Name
This field is for validation purposes and should be left unchanged.

I understand the information disclosed in this form may be subject to re-disclosure and may no longer be protected by HIPAA privacy regulations and the HITECH act.

Office Address

7373 N. Scottsdale Road, Suite A-220 Scottsdale, AZ 85253
Phone: (480) 991-2290
Fax: (480) 991-6933
Email: drkidess@pvsmiles.com

Office Hours

Monday	8:00AM – 5:00PM
Tuesday	8:00AM – 5:00PM
Wednesday	8:00AM – 5:00PM
Thursday	8:00AM – 5:00PM
Friday	8:00AM – 12:00PM