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White Plains Dentist » Registration Forms » health-history-form

health-history-form

health-history-form

New Patient Offer

New Patient Comprehensive Examination

Only $150

Includes full set of digital x-rays
and oral cancer screening
(Save over 60%!)
Limited to the first 50 new patients

Call us today at
914-683-5898
to make an appointment.

Contact Us

Sidebar Contact Form

Name *

Email *

Phone *

Message

*

By providing my wireless phone number and/or email, I agree and give consent to receive communication from The Dental Design Center via text message and/or email.

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If you are human, leave this field blank.

Review Us

Testimonials

Dr. Ira, I remember as a young child running from the dining table, screaming, “No, no, no” at the mention of having to “visit” the dentist. The apprehension I felt about dental work stayed with me through most of my years until I met you. Not only have you proven to me that dental procedures…

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Our Location

The Dental Design Center - Cosmetic, Implant & General Dentistry

280 Dobbs Ferry Rd Ste 104
White Plains, NY 10607

Call: 914-683-5898

The Dental Design Center - Cosmetic, Implant & General Dentistry Westchester County Office:
280 Dobbs Ferry Rd Ste 104
White Plains, NY 10607

Phone: 914-683-5898

Contact Us

Contact Us

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White Plains dentist Dr. Ira Handschuh, DDS, provides cosmetic dentistry, dental implant restorations and general dentistry in his White Plains office and serves patients from throughout the Westchester County area including Scarsdale, Elmsford, Tarrytown, Ardsley, Briarcliff Manor, Bronxville, Yonkers, and Rye Brook.

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Request an Appointment

health-history-form

Appointment Request

Name *

Email *

Phone *

Are You Currently a Patient? *

Yes

No

Preferred time(s) to call?

Morning

Noon

Afternoon

Evening

Preferred days of the week for an appointment?

Any Day

Monday

Tuesday

Wednesday

Thursday

Friday

Preferred time(s) for an appointment?

Any Time

Morning

Noon

Afternoon

Evening

Please describe the nature of your appointment (e.g., consultation, check-up, etc.): *

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TEXT OUR OFFICE

Your Name: Your Cell Phone Number: Text Message:

Text message is limited to 160 characters.

HOW IT WORKS

Enter your Name.
Enter your Cell Phone Number, area code first
Enter your text message in the box.
Click "Send Text"
A copy of this text will be sent to the office and to your cell phone. The office's reply will also be sent to your cell phone where you can continue the text conversation.

Note: Mobile message and data rates from your cell phone carrier may apply.

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