Request a Dental Screening:

Dental Screenings are a visual inspection of the oral cavity. Free to all those interested under the age of 18. The purpose of these screenings are to make guardians aware of their children’s oral health and treatment needs.

Please complete the form below and an NCHC representative will make contact for more information and to confirm the appointment requested.

This is not an appointment or cancelation confirmation.

Hours of operation for NCHC are Mon-Fri 8:00-5:00 and Saturday 8:00-12:00.

Calls will be returned during our normal business hours.

If this is an emergency, please call 911.

Name of Person for Requested Appointment:(Required)

First Last

Parent Name:

First Last

Date of Birth for Person Requesting Appointment:(Required)

Address:(Required)

Street Address Address Line 2 City State ZIP Code

Phone# for NCHC to Contact:(Required)

Email:(Required)

Enter Email Confirm Email

Please select an appointment time:

Message to NCHC:

Anything you would like our representatives to know before contacting you?