Accepting New Patients

The first step toward your child’s healthy smile is to schedule an appointment with The Pediatric Dental Studio. Complete the appointment request form below, and our scheduling coordinator will contact you to confirm your appointment. If you need to cancel or reschedule an existing appointment or if you require immediate assistance, call us directly at 601.965.9549.

Important Notice

We require new patient health forms to be filled out at least 48 hours prior to your child’s appointment to ensure insurance verification and any medical restrictions that may hinder any cleanings/ exams/or treatment
Dental Appointment Request

Your Contact Information

Address
Address
City
State
ZIP Code

Patient's Information

Important Notice

We require new patient health forms to be filled out at least 48 hours prior to your child’s appointment to ensure insurance verification and any medical restrictions that may hinder any cleanings/ exams/or treatment.

Complete Online Health Information

Sex

Appointment Request

Preferred Time
Reason for Visit

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