Continuing Care Appointment

For Current Patients of Dr. Thomas N Heap

Please call me to schedule an appointment for a comprehensive cleaning appointment with your hygienist and an examination of my teeth and gums by Dr. Heap. Please call me as indicated below:

Please provide the following contact information:

Title & First name	Mrs. Mr. Ms. Dr.
Last name
Middle initial
Work phone
Home phone
Call me	at home or work at home at work
The best time is
E-mail
We respect your email privacy. We promise to never sell, barter or rent your email address to any unauthorized third party. Please be aware that the information above will be sent via email and/or fax.