Parent Full Name

Patient Name (If Different from Above)?

Phone *

Preferred Time *

Mornings

Afternoons

Any Time

Based on your selection below, that office will reach out to you and schedule your wisdom teeth removal appointment with The Molarnator.

Which Location & Office Would You Like to Schedule With? *

Layton Hills Dental - Layton

Tooth Co - West Valley

Rose Creek Dental - Riverton

Professional Dental - West Jordan

Professional Dental - Draper

Ultratooth Utah - Pleasant Grove

Frandsen Family Dental - West Jordan

Frandsen Family Dental - Orem

Frandsen Family Dental - Grantsville

Family Legacy Dental - Orem

Johnson Family Dental - Payson

Neil J. Dansie DDS - Payson

Salina Creek Dental - Salina

By providing my phone number, I agree to receive text messages and emails from Dan W. Dansie DDS - The Molarnator.