Request Appointment We are not a Medicaid provider nor the Augusta Regional Dental Clinic.

Your Name*
Your E-mail Address*
Your Phone Number*
How did you hear about us?
Comments/Questions
Untitled
- By submitting this form and signing up for texts, you consent to receive customer care text messages (appointment confirmations) from Augusta Dental at the number provided, including messages sent by auto dialer. Consent is not a condition of purchase. Msg & data rates may apply. Msg frequency varies. Unsubscribe at any time by replying STOP. Reply HELP for help. Privacy Policy.
Initials
This field is for validation purposes and should be left unchanged.

Patient Registration

Online Forms for New Patients

Please click on the link below to complete the new patient forms prior to your first appointment. The link below will take you to a secure site to complete the forms. Please contact us by e-mail at [email protected] or by phone at Augusta Dental Phone Number 540-885-4589 if you have any questions. We look forward to meeting you and to becoming your oral health care provider. Thank you.

Augusta Dental New Patient Forms