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Just one more step!
Just The Last Few Questions
Please fill out the short form below & let us know which $50 gift card you want.
We'll call you to schedule your first appointment. Upon completion of your first visit, we'll email you your reward.
Tap Below To Select Which Gift Card You Would Like
Visa - $50
Nordstrom - $50
Amazon - $50
Target - $50
Mac Cosmetics - $50
Lululemon Athletica - $50
Reserve My $50 Gift Card!
Reward your smile. Get your $50 gift card.
Reward your smile. Get your $50 gift card.
Complete the short survey to reserve your $50 gift card. There are 5 questions total.
What's the reason you need to visit a dentist?
Let us know how we can help give you the best care - even if you just need a check up!
Cleaning & Check Up
Specific Treatment
Urgent Issue
Do you have dental insurance?
We want to make sure you can use your benefits for your visit!
Yes, PPO
Yes, HMO
Yes, Government Assistance (Denti-Cal, Etc.)
No, I Don't Have Insurance
How long has it been since you last visited the dentist?
We're not judging! This just helps us serve you better (:
> 1 year
1-2 Years
2-3 Years
So long, I can't remember
Do you have a preferred time to see the dentist?
Select what applies.
Early (Before 9am)
Morning (9am - 12pm)
Noon (12pm - 2pm)
Afternoon & Evening (2pm - 8pm)
Weekends
No Preference
Where do you live in Southern California?
This will help us match you with one of our participating locations!
San Diego, CA
Downey, CA
Valencia, CA
Simi Valley, CA
Temecula, CA
San Dimas, CA
Agoura Hills, CA
Long Beach, CA
Complete the short survey to reserve your $50 gift card. There are 5 questions total.
What's the reason you need to visit a dentist?
Let us know how we can help give you the best care - even if you just need a check up!
Cleaning & Check Up
Specific Treatment
Urgent Issue
Do you have dental insurance?
We want to make sure you can use your benefits for your visit!
Yes, PPO
Yes, HMO
Yes, Government Assistance (Denti-Cal, Etc.)
No, I Don't Have Insurance
How long has it been since you last visited the dentist?
We're not judging! This just helps us serve you better (:
> 1 year
1-2 Years
2-3 Years
So long, I can't remember
Do you have a preferred time to see the dentist?
Select what applies.
Early (Before 9am)
Morning (9am - 12pm)
Noon (12pm - 2pm)
Afternoon & Evening (2pm - 8pm)
Weekends
No Preference
Where do you live in Southern California?
This will help us match you with one of our participating locations!
San Diego, CA
Downey, CA
Valencia, CA
Simi Valley, CA
Temecula, CA
San Dimas, CA
Agoura Hills, CA
Long Beach, CA
Your answers help us give you the best care possible. All your information will remain private.
Your answers help us give you the best care possible. All your information will remain private.
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Cleaning & Check Up
