Schedule Your Next Appointment!

If you are a new patient or would like information on a dental procedure, simply enter the requested information below, click "send" and your request is on its way to the doctors and staff at Buttercup Dental! Please print and fill out the following PDF forms prior to your visit:

Patient Information Form (in Adobe PDF format)
Medical Information Form (in Adobe PDF format)

• Please note that the preferred Appointment date / time is subject to availability.
• Our staff will contact you within 1-2 working days to confirm appointment date and time
• Please ensure that the above information entered is valid.

Name*:
Address*:
City*:
State, Zip*:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY
Birthday:	(m/d/yy)
Age:	Age 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110
Home Phone*:
Cell Phone:
Work. Phone:
Email Address*:
Preferred Method of Contact*:	Home Phone Work Phone Home E-mail Work E-mail
Services Interested In:	Check-Up Cleaning Whitening InvisAlign Bonding & Veneers Implants Replacing Teeth White Fillings Crowns & Bridges Other:
Preferred Day and Time:
1st Choice:	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008 2009 2010 Time Early Morning Late Morning Mid-Day Early Afternoon Late Afternoon
2nd Choice:	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008 2009 2010 Time Early Morning Late Morning Mid-Day Early Afternoon Late Afternoon
3rd Choice:	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008 2009 2010 Time Early Morning Late Morning Mid-Day Early Afternoon Late Afternoon
Additional Comments:	Please note that the preferred Appointment date / time is subject to availability. Our staff will contact you within 1-2 working days to confirm appointment date and time Please ensure that the above information entered is valid
Security Code

Conveniently Located in Cedar Park!

Office/Mailing Address

Buttercup Dental
901 Cypress Creek Road. Suite 203
Cedar Park, Texas 78613

Telephone:

512.335.8121

FAX:

512.335.0186

Email:

info@buttercupdental.com

Office Hours:

MONDAY:	7:30 to 5:00
TUESDAY:	7:30 to 7:00
WEDNESDAY:	7:30 to 7:00
THURSDAY:	7:30 to 7:00
FRIDAY:	7:30 to 4:00