PA Department of Health Ruling Regarding Dental Appointments

Request Appointment Online

Request appointment online with $100 deposit or call 1 (855) 4 NO FEARS any time!

Save time by requesting an appointment online and getting some of that paperwork out of the way early. The $100 deposit collected at the bottom of this form is applied in full to your balance.

Or simply call 1 (855) 4 NO FEARS to book your appointment by phone.

  • Date Format: MM slash DD slash YYYY
  • Contact Information

  • Preferred Appointment Date & Time

  • Date Format: MM slash DD slash YYYY
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  • Dental Priorities

  • Enter 'none' if you have no insurance
  • Enter 'none' if you have no insurance
  • Enter 'none' if you have no insurance
  • Price: $100.00
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