Appointment Request Form

Phone

This field is for validation purposes and should be left unchanged.

Limited-Time Offer for New Paradise Dental Discount Plan Members!

Sign up now and receive a gas voucher after your first free consultation visit—voucher value depends on the plan you choose! This special offer is available while supplies last, so don’t miss out. To get started, simply complete this form to schedule your appointment.

Important Scheduling Information:

Online dental appointment requests must be made at least 48 hours in advance.
Your appointment is not confirmed until one of our team members contacts you.
We’ll do our best to accommodate your requested date and time.

Please Note:

Gas vouchers are only available to new Paradise Dental Discount Plan members. Gas vouchers will be provided after enrolling in the the Island Smiles Discount Dental Plan.

Name(Required)

First Last

Date of Birth(Required)

Contact No.(Required)

Do you have dental insurance?(Required)

Yes

Dental Insurance(Required)

Cigna

Takecare

Staywell

Hawaii Dental Services (HDS)

Calvo’s Select Care

Delta Dental

Logistics Health Incorporated (LHI)

Paradise Dental Island Smiles Discount Plan

Other

Insurance Company(Required)

Have you visited Paradise Dental before?(Required)

Yes

No, this is my first time.

Online dental appointment requests should be made at least 48 hours in advance. Please note that your appointment is not confirmed until you have been contacted by a member of our team. We will reach out to confirm your appointment and do our best to accommodate your requested date and time.

Requested Appointment Date(Required)

Requested Appointment Time(Required)

Has anyone referred you to Paradise Dental?(Required)

Yes

Your referral gets something special too! Fill out their information below, and we'll send them a thoughtful thank-you surprise!

Referral Name(Required)

First Last

Phone(Required)

This field is hidden when viewing the form

Admin Fields

This field is hidden when viewing the form

Contacted

Yes

This field is hidden when viewing the form

Notes

$49

Limited-Time Offer for New Paradise Dental Discount Plan Members!

Important Scheduling Information:

Please Note:

Admin Fields

Meet Our Team

Paradise Dental Discount Plan

a plan for everyone

Other plans welcome

Connect with Us

*in the absence of gum disease and heavy stain

Copyright © 2023 Paradise Dental Spa. All Rights Reserved. Powered By TurnKey Solutions