Home Appointment Preference Form Please fill out all these forms before your first visit: ☐ Medical History Form ☐ Patient Account Information ☐ Appointment Preference Form ☐ Corah's Dental Anxiety Scale ☐ Mount Sinai Dental Fear Inventory First Name Last Name Home Phone Work Phone Email I prefer my appointments: First Preference: select your first preference here Early morning (8 AM - 9:30 AM) Mid-Morning (9:30 AM - 11:30 AM) Lunchtime (12 Noon - 2 PM) Midafternoon (2 PM - 4 PM) Late Afternoon (4 PM - 6 PM) Second Preference: select your second preference here Early morning (8 AM - 9:30 AM) Mid-Morning (9:30 AM - 11:30 AM) Lunchtime (12 Noon - 2 PM) Midafternoon (2 PM - 4 PM) Late Afternoon (4 PM - 6 PM) We will call you to arrange an appointment at your preferred time and look forward to meeting you! This site and contents ©2008 Michael Krochak, DMD All Rights Reserved Our Philosophy of Care Restorative Dentistry Cosmetic Dentistry Our People Dental Technology Services and Amenities Appointments Emergencies Fees and Insurance Processing Share a Smile