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	Dr. Alexander Eduardo R. Garcia Sacred Heart Dental Clinic 129 Asuncion Street Morning Breeze Caloocan City, 1400 Philippines +632 3305750 +63918 9366697


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	Our practice is located in Manila. Click below to find a local dentist in another City or State:

PATIENT APPOINTMENT SCHEDULER
* Indicates field is required
Active Patient Inactive Patient New Patient
Name: *
Home Phone:
Office Phone:
Email: *
City:
State:
Zipcode (postal code): *
Country: *
Referral Source: (new patients only):
PURPOSE OF DENTAL VISIT (you may select more than one choice):
Bleaching/whitening	Bonding
Braces	Broken or missing teeth
Cleaning & check-up	Cosmetic dentistry
Crowns, caps & fixed bridges	Dentures
Diagnosis of soft tissue lesions	Emergency
Examination	Extraction
Fillings
Implants	Oral Microbiology
Oral Surgery	Pain
Periodontal (gum) therapy or surgery	Porcelain laminates/veneers
Post and core	Reevaluation
Retainers (fixed or removable)	Root canal therapy
Root planning & scaling (deep cleaning)	Sculpting (reshaping teeth)
Temporary filling or caps	TMJ & bite plates
Wisdom teeth	X-rays
Please provide more details in the box below:
PREFERRED DAYS AND TIMES OF APPOINTMENTS Office hours: Monday - Friday, 9:00 am - 6:00 pm (last appointment) (Please give several choices):
Preferred Time of Day: *
Preferred Days and/or Dates: *
Preferred Provider (if any):
APPOINTMENT CONFIRMATION (Preferred method to receive your appointment confirmation) :
* One appointment confirmation method is required Home Phone Office Phone Email
If you send this Patient Appointment Scheduler to us during the week between 9:00 am and 5:00 pm you will receive your confirmation by the end of the day. You will receive your appointment confirmation on the next business day if you contact us after business hours.

Dr. Alexander Eduardo R. Garcia
Sacred Heart Dental Clinic
129 Asuncion Street Morning Breeze
Caloocan City, 1400
Philippines
+632 3305750
+63918 9366697

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