accessibility ACCESSIBILITY

Appointment Request


The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our Katy Cosmetic dental office by phone @ 281-656-2200 or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Office Hours
Monday: 10:00am - 7:00pm
Tuesday:9:00am to 5:00pm
Wednesday: 9:00am to 5:00pm
Thursday: 10:00am to 7:00pm
Friday: Closed
Saturday: 9:00am to 3:00pm

If you are a new patient to our Katy dental office, the forms below will need to filled out when you arrive for your first appointment in our dental office. Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival.  Thank you and please call our dental office if you have any questions or need any assistance. 

Please click on the links below to open and print out these forms.

  1. Patient History
  2. Notice of Privacy Practices Acknowledgement
  3. Financial Policy
  4. Payment Policy
  5. Cancellation Policy


  1. Historia del Paciente
  2. Aviso de prácticas de privacidad Reconocimiento
  3. Política Financiera 
  4. Poliza de Pago
  5. Poliza de Cancelacion


This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

                                  Usted necesitará Adobe Acrobat Reader para abrir estos for

*Items in bold are required.
Are you a current patient?

Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.


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