Main Street Children's Dentistry and Orthodontics of Lakewood Ranch

Request an Appointment

When applicable, appointments are to be scheduled in advance. During our office hours every effort is made to stay on schedule, however emergencies occur and our dentists & hygienists can be delayed. Please be sure to provide an email and phone where you might be reached prior to your appointment and feel free to call us to confirm your appointment status.

Online Patient Registration

For all new and existing patients. Please complete the online registration form after scheduling an appointment for your dental care.

Patient Name*:
Patient Date of Birth*:
Responsible Party Name:(if different)
Patient Type*:
Preferred Day*:
Preferred Time*:
Email*:
Phone*:
Contact Me*:


Payment Method*:
Questions / Comments: