This form allows Dr. Hinkle to do a preliminary review of your case online. Please fill out the form to initiate this process. We will review your case and contact you as soon as possible to go over your dental options. Thank you for contacting our practice.

	Please answer all questions
	Patient Name:

	E-mail Address:

	Phone Number:

	1. List in priority the things you would most like to improve about your smile.

	2. Have you had any previous esthetic dentistry? (If no, go to question #4)

	a. What was the reason for your previous work?

	b. When was your last dental visit?

	c. Who was your dentist? (name of doctor)

	3. Do you have any interest in teeth whitening or orthodontics?

	4. Do you have Dental Insurance? Please list your carriers, plan, etc.

	5. Do you have an idea of your dental budget so that we may plan accordingly?

	6. If you have not had another dental makeover, what are your realistic desires (i.e., what will/would it take for you to be satisfied with the outcome)? Think about this and be honest.

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printable map of our location.

Click here to obtain point-to-point
driving directions.

Mike Hinkle, DDS
1768 South Utica Ave.
Tulsa, OK 74104
________________________

P / 918-745-0994
918-712-0000
F / 918-745-8971

Did you know?
We are proud to support the Dental
Financing Plan (DFP). Please contact our
office today to find out more information
regarding your personal options. We
believe that everyone should have the opportunity to love their smile!


Mike Hinkle Cosmetic Family Dentistry of Tulsawould like to thank Glamour Shots� Photo Studios for supplying the beautiful "after" Photos of our patients new smiles. Home :: Our Practice :: Our Doctors :: Procedures :: Smile Gallery :: Candidate Copyright � 2004 Dr. Mike Hinkle, DDS, All rights reserved. Developed by Einstein Dental