Thank you for your interest in Special Smiles!

For all new patients, Special Smiles requires a screening/consultation appointment to determine if the patient is a candidate and what clearances each patient requires for the surgical treatment appointment. Patients must be referred to us from either a dental provider or a medical doctor for treatment under General Anesthesia.

Prior to scheduling the screening appointment we will need the following information:

• New Patient Intake/Health History Form
• Referral from Dentist for Treatment under GA with Xrays or
• Letter of Necessity from Primary Care Physician

Please upload either the Dental Referral (and x-rays of applicable) or the PCP Letter of Necessity to the New Patient Intake/Health History Online Form (see above).  Note:  All Referrals/Letters of Necessity must say “Patient is being referred to Special Smiles for treatment under General Anesthesia” and note the reason why.

Please obtain medical clearances/consents only after initial screening has been completed.

Once Special Smiles receives the above requested information, you will be contacted by an associate to schedule the evaluation.

Questions? Feel free to contact us via phone at 267-639-6250.