Clive Dentist         Douglas R Pick DDS PLC         TMJ Dentistry

Douglas Pick DDS
1250 Northwest 142nd Street Suite 201 = Clive IA = 50325 = (877) 724-5334
100 2nd Street NE = Bondurant IA = 50035 = (877) 724-5334
  Home Appointments
What we offer Ask the dentist
Meet the dentist Newsletter sign up
Map & Hours Financial options


 

For New Patients

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.

Please provide the following contact information:
Title & First name
Last name
Middle initial
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work/Cell phone
Home phone
Call me at
Best time is
How did you hear
about us?		  
Fax  
E-mail
Referred By
(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.
 

 

Call (877) 724-5334 Now To Make An Appointment


Dentist
In Clive Iowa and the surrounding
West Des Moines - Waukee - Ankeny - Altoona IA areas.
Home | What we offer | Meet the dentist | Map & Hours| Appointments | Ask the dentist | Newsletter | Financial options

Copyright 2007    Internet Dental Alliance, Inc.

Terms Of Use