Donate Online: ImpactGiveback.org

Or give us a call us during work hours:

(701) 221-0518

New Patients

To get started filling out our online forms please follow the secure link HERE.  (Please select today’s date as date of appointment as one hasn’t been set yet.) This is a new system that integrates directly into our dental software.

 

 

 

Income Worksheet:  The Income Worksheet needs to be filled out so that we can let you know how much your out of pocket expense will be based on the sliding scale.  While we do have a sliding scale for payment we are happy to see all members of the community!

Download Here