Forms

Schedule An Appointment

Please let us know your preferred availability and we will be in touch to confirm very soon.

We look forward to seeing you!

Request an Appointment

Name*
Email*
Phone*
Street Address (optional)
Address City State Zip
Are You A Current Patient?*
- Yes
- No
Best Time To Call*
Preferred Day(s) Of The Week*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Preferred Appointment Time*
Describe The Nature Of Your Appointment (e.g., consultation, check-up, etc.)*

67437

Dentists: Refer a Patient to Us

Fill out this form to be submitted online to refer a patient to one of our specialists. All submissions are confidential and directly sent to our patient coordinators.

Thank you for the referral!

Referral Form for Other Practices

This form is for other doctors to complete electronically to refer a patient to a specialist at Worthington Dental Group.

New Patients

We currently offer printable versions of paperwork needed at your first appointment. Complete it at your convenience and bring it with you: