Book your visit today

To schedule your appointment or book a consultation, please complete the form below or give us a call at (760) 741-5775.

We take your privacy seriously. Please refrain from providing any personal health or sensitive information.

Are you a new or existing patient?*
- New Patient
- Existing Patient
Full name*
Phone*
Email*
Reason of emergency*
Availability*
- Monday
- Tuesday
- Wednesday
- Thursday
Preferred Appointment Window*
Please select the 1-hour window(s) that work best for you. TLC Escondido Dental will reach out to schedule your appointment.
- 7:30 AM - 8:30 AM
- 8:30 AM - 9:30 AM
- 9:30 AM - 10:30 AM
- 10:30 AM - 11:30 AM
- 11:30 AM - 12:30 PM
- 12:30 PM - 1:30 PM
- 1:30 PM - 2:30 PM
- 2:30 PM - 3:30 PM
- 3:30 PM - 4:30 PM
New Patient Information
Date of Birth*
Date Format: MM slash DD slash YYYY
Do you have insurance?*
- Yes
- No
Insurance Provider*
Member ID*
Group ID*
Name of Insured*
First Last
*
- By submitting this form, you agree to our storage and data handling practices according to our Privacy Policy.
- I acknowledge that TLC Escondido Dental cannot give medical advice or recommendations sent via this form, therefore such inquiries will not be responded to. You must agree to this acknowledgment before sending your inquiry.
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