W. Madison Home First Visit Dental FAQ Fitchburg East Madison West Madison Appointment Request West Madison Appt. Request Contact Request Pay 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 - West 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

W. Madison Home First Visit Forms Dental FAQ Fitchburg East Madison West Madison East Madison Contact Forms Request Pay At Children’s Dental Center of Madison in East Madison, Dr. Anthony Hernandez and Dr. Cecelia Thompson and their team can’t wait to meet you. They have the same philosophy as all the Children’s Dental Center of Madison locations…they will provide your children with the best oral health care in a safe, friendly, and welcoming environment. The American Academy of Pediatrics (AAP), American Dental Association (ADA), and the American Academy of Pediatric Dentistry (AAPD) each recommend establishing a “Dental Home” for your child by the age of one. Studies have shown that a child who has a regular dental home is more likely to receive the preventive and routine oral health care necessary for a happy and healthy smile. We hope you choose Children’s Dental Center of Madison in East Madison as your child’s Dental Home! Meet the East Madison Doctors Anthony Hernandez, D.D.S. Understanding each individual child and creating a fun environment that uniquely suits that child is an everyday goal of Dr. Hernandez. His tireless enthusiasm towards children’s dentistry helps the patient and parents relax and enjoy their time together at the office. Read More Cecelia Thompson, D.D.S. Dr. Cecelia “Cece” Thompson joined Children’s Dental Center of Madison in July 2014. She and her staff strive to create positive experiences for their young patients as they receive excellent dental care. Read More Meet the East Madison Team Coming Soon 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