New Patients

Request an Appointment

Thank you for considering Liberty Dental Centers as your dental provider! We are currently accepting new patients and look forward to meeting you.

Please complete the following information and a member of our team will contact you to schedule your New Patient Examination.

Once your information is received, please look for an email with your New Patient Forms. These must be completed prior to your first appointment with us.

For any questions, please feel free to call the office at 681-207-7063.

Type "N/A" in any field that is not applicable to you.
Patient's Name*
First Last
Patient's Date of Birth*
MM slash DD slash YYYY
Patient's Social Security Number*
Patient's Email*
Patient's Phone Number*
Patient's Secondary Phone Number*
Patient’s/Insurance Subscriber’s Name*
First Last
Employer Name*
Insurance Company Name*
Insurance Subscriber Social Security Number*
Insurance Identification Number/Member Number*
Insurance Group Number/Policy Number*
Reason for Appointment*
How did you hear about us?*
Comments/Questions*
Address
This field is for validation purposes and should be left unchanged.

Proudly Serving Nearby Locations
Fayetteville WV • Oak Hill WV • Mount Hope WV • Princeton WV • Beaver WV

New Patients

What to expect at your New Patient Appointment