Welcome to Family Dental Care of Fitchburg

Ready to request an appointment?

Oh snap! It looks like something on the page broke. You can book an appointment by calling our office at 608-286-1466, or you can click here to refresh the page and try again.

You are viewing this page in "Demo" mode as a patient would see the page if they were patient. Click around and take it for a test drive, but when you request an appointment in demo mode, the appointment is NOT transmitted to your system.

5401 Caddis Bend Rd., Unit B, Fitchburg, Wisconsin 53711•

608-286-1466 •

www.familydentalcareoffitchburg.com

Family Dental Care of Fitchburg

Online Scheduler

Let's request an appointment:

Location

Provider

Please select provider and location to get started.

Patient Information

First Name *

Last Name *

Email Address *

Phone Number *

Address Line 1 *

Address Line 2 *

City *

State/Province *

Zip/Postal *

Gender *

Date of Birth *

Responsible Party Information

You've indicated that the patient is under the age of 18. Please provide contact information for the parent or legal guardian.

First Name *

Last Name *

Email Address *

Phone Number *

Supplementary Information

What Dates/ Times are best for you? *

Purpose of Visit *

Insurance Provider *

Group ID *

Member ID *

Insurance Card Photo Upload

Browse…

Browse…

Primary Policy Holder Information

Are you the primary policy holder? *

YES NO

First Name *

Last Name *

Date of Birth *

Last 4 digits of SSN *

Comments *

Powered By