BECOME A DENTAL PATIENT

 

Thank you for your interest in becoming a Dental patient at one of our Kidney Beans Dialysis Health & Wellness facility(s).

In addition to your name and contact information, we need some basic information so we can better process your request. Please enter this information in the Message portion of the form on the right and one of our Kidney Beans Dialysis Health & Wellness staff will contact you within 24 hours: 

  • Age
  • Gender
  • Current Dental Office
  • Current Dentist
  • Approximate Date of Last Dental Visit
  • Preferred Day(s) for Appointments
  • Preferred Time for Appointments: Morning, Mid-Day or Afternoon 

Your information, whether public or private, will not be sold, exchanged, transferred, or given to any other company for any reason whatsoever, without your consent, other than for the express purpose of delivering the information requested. See our Privacy Policy for more information.