Dental Appointment / Information Request

Solicitud de cita / información dental

Please fill out the following form to help us understand your dental needs

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REMINDER:  We ONLY offer Exams, X-Rays & Extractions

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WE ARE ONLY ABLE TO SERVE THOSE LOCATED IN WASHINGTON STATE

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SÓLO PODEMOS SERVIR A AQUELLOS UBICADO EN EL ESTADO DE WASHINGTON

Serving Washington State Only

Outside Washington Visit

National Association of Free Clinics www.nafcclinics.org

Sirviendo el estado de Wasington solamente

Fuera de Washington

Visite la Asociación Nacional de Clínicas Gratuitas www.nafcclinics.org

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