Great Smiles Wellness Plan

Enrollment Form
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Enrollment in our Great Smiles Wellness Plan is easy.

  1. Call our office and schedule your Great Smiles Wellness Plan New Patient Appointment for you and your participating family members. Or, if you have questions, complete the form below and ask our office to call you to schedule your appointment.
  2. Complete the online enrollment form below. Or, click here to download a fillable form and email it to
  3. Visit our office for your New Patient Appointment. Enrollment fees will be due at the time of service.

Primary Participant Information


Plan Participants





I agree to all terms of this plan and agree to enroll
Free Whitening for Life
Schedule your new patient appointment and receive free whitening for life*! Refer a friend or family member for free whitening, as well.
Learn More
New Patient Forms
Complete our new patient forms here. They submit directly to our patient records system so you don’t have to print!
Complete Forms
Dental Wellness Plan
No insurance? Participate in our Dental Wellness Plan. We want to make comprehensive dental care affordable for all families.
Sign Up
Schedule Now
We offer convenient hours for your schedule.
Mon – Thur7AM – 5PM
Fri7AM – 2PM