W. Madison Home First Visit Forms Dental FAQ Fitchburg East Madison West Madison Blog Children's Dental Center of Madison Blog Snacks for Healthy Teeth Concerned parents often ask us which kinds of snacks are best for a child’s teeth. While most know that candy isn’t always the best choice, READ MORE » July 1, 2021 Can a Night Guard Mean Sweet Dreams for Your Child? Sometimes the reason for a poor night’s sleep is obvious. Maybe your child watched a scary movie. Or loaded up on sugar before bed. Or READ MORE » June 3, 2021 Brushing: Before or after breakfast? In a perfect world, we would all jump out of bed ready to greet the day with a big smile and a toothbrush close at READ MORE » May 20, 2021 FITCHBURG 5544 E. Cheryl Pkwy Fitchburg, WI 53711 (608) 288-1543 EAST MADISON 5116 American Family Dr Madison, WI 53718 (608) 825-7500 WEST MADISON 7001 Old Sauk Rd., Ste 200 Madison, WI 53717 (608) 833-6545 All rights reserved ©2021 Children’s Dental Center of Madison & Magnify Dental Marketing

W. Madison Home First Visit Forms Dental FAQ Fitchburg East Madison West Madison Appt. Request Contact Request Pay Appointment Request East Madison Thank you for choosing our office for your child’s/children’s dental care. All information in this form is confidential and transmitted over a secure, encrypted connection and will not be sold to any third party. Please fill out the form below and one of our friendly team members will contact you to schedule your appointment. Parent/Guardian First Name: Parent/Guardian Last Name: Mobile Number: Secondary Number: Email Address: Patient's Name: Patient's Age: Patient's Gender: Preferred Appointment Date: Preferred Time of Day: No Preference Morning Afternoon If date is not available, preferred day of week No Preference Monday Tuesday Wednesday Thursday Friday Reason for Appointment: Exam, Cleaning and X-Ray Toothache or Other Emergency Recommended Treatment Other (explain in comment box below) Comments Send Contact Us - East Madison Name Email Phone Message Send Call Us Email Us M – Th: 7:30am – 4:30 pm F: 7:30am – 3:00pm All rights reserved ©2021 Children’s Dental Center of Madison & Magnify Dental Marketing