Appointments Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment. Which Location?Please SelectFt. LauderdaleLighthouse PointReason For Visit:*$89 New Patient SpecialComplimentary Implant EvaluationExisting PatientName*Phone*Email* Preferred Date* Date Format: MM slash DD slash YYYY Preferred TimeMorningAfternoonEveningNature of VisitNameThis field is for validation purposes and should be left unchanged.