Dentist Plano Appointment Request

General Dentistry in Plano TX Scheduling

Need an appointment with a dentist in Plano? Requesting an appointment at our Plano, TX family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with Dr. Alexander M. Kasiri today!

 

For your convenience, we now offer patient forms online that you're able to download, print, fill out, and bring in so you won't have to during the time of your appointment.

 

** Or click on the "Contact Us" Page and feel free to fill out the online forms and they will be sent directly to us with no printing necessary.

 

Health History Form

 

Patient Insurance Information Form

 

HIPPA/Patient Consent Form

 

General Consent Form

 

Financial
We will submit all insurance forms for you and help you recover the most from your benefits. We will do everything we can to help you afford the treatment you need and want. For patients who require major work, we have several payment options, including Carecredit and the Dental Fee Plan. Forms of payment accepted by the office are check, cash, or any major credit card. 

 

Cancellation
If you are unable to keep an appointment, we ask that you kindly provide us with at least 24 hours notice. We ask for this advance notice so that we can offer this appointment to another patient. A fee will be charged if a patient does not show up for an appointment without sufficient notice.
 
We would like to take this opportunity to thank you for choosing our practice for your dental care. 
Patient Information (* denotes fields that are required)
Patient Name*
Phone Number*
Email Address
Are you a current patient?
No Yes
Best time(s) to call?
Morning Noon Afternoon Evening
Appointment Information
Preferred Appt Date
Preferred Appt Time
Message
Describe the nature of your appointment or any other comments