Appointment Request | Shoal Creek Pediatric Dentistry

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Dr. Scott Thomas, DDS

Barry Pointe Medical Plaza
9051 N.E. 81st Terrace, Suite 220
Kansas City, MO 64158
Tel: 816-781-KIDS (781-5437)

Taking pride in serving patients from Shoal Creek and surrounding areas (Liberty, Claycomo,
Pleasant Valley, Kansas City, Gladstone, and Smithville) with kindness and understanding

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Day-Time Phone Number
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I would like to (choose one):	Schedule a new patient appointment Schedule a routine appointment Schedule a comprehensive exam Reschedule an appointment Not sure (For example: My teeth hurt and I need to see the doctor.)
Are you currently a patient with us?	Yes No
If you are a new patient, where did you first hear about the practice?	From a Friend Yellow Pages Your Web Site Through a Search Engine (Google, Yahoo!, etc.) Other
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