New Patients - Make an Appointment Online

New Patient Appointments

Just complete the following form and one of our team members will contact you as soon as possible to schedule a convenient time for your first appointment.

Title & First name     
Last name
Middle initial
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work phone
Home phone
Call me at     
Best time is
How did you hear
about us?		     
FAX
E-mail
Referred by (e.g., Mrs. Jones)

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.

Payas Dental Restoration

5314 South Yale Avenue, Suite 1100
Tulsa, OK 74135

Appts: (877) 841-2034

 

 

 
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(877) 841-2034

General Info: (918) 492-3003