Family Dentistry
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952-541-9984
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Kenneth J. Starcznski, D.D.S.
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Patient's first and last name
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Patient's birthdate
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For positive identification
Email address, OR daytime phone number (your choice)
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In case we need to contact you
What is the purpose of this appointment
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Cleaning and Examination
Treatment with Doctor
Emergency (tooth ache)
Consultation / Second Opinion
Other (please explain below)
How soon would you like to come in?
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Next week
Whenever you have time available
As soon as possible
In two weeks
Availability
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Please state any preferences you may have for your appointment here
Monday: 11am-3pm
Monday: 4pm-8pm
Tuesday: 8am-1pm
Tuesday: 2pm-5pm
Wednesday: 7:30am-12:30pm
Wednesday: 1pm-4pm
Thursday: 8am-12pm
Friday: 7am-12pm
Please tell us any additional special date / time requirements
If you would like us to make an appointment for other family members, please list the names here
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