New Patient Form


We look forward to meeting you on your first visit! Please review the checklist below to ensure that our office is able to take great care of you.  Having your paperwork filled out prior to the appointment helps to ensure that we can start your appointment on time, as well as remain on time for other patient appointments:

  • Fill out the new patient form (Found Above)
  • Current dental insurance information
  • If we are considered an out-of-network provider with your PPO plan, we can still file your claims for you. You will only be responsible for the portion that your insurance does not pay.
  • Payment is due the day of service. We accept Visa, MasterCard, American Express and Discover, as well as cash or check. We also work with Care Credit and Lending Club to provide financing options.
  • If an appointment is canceled or rescheduled with less than 48 hours’ notice, you will be subject to a $75.00 fee. We will email, text and/or call to remind


04 Dental is located on the East side of South Lamar, two doors down from Broken Spoke and right next door to Lavaca St Bar.


We have free parking in the back of the building. Look for the “Retail Parking” arrow between Lavaca Street Bar and Broken Spoke.

Monday-Thursday: 7:30 am - 4:00 pm Friday: 7:30 am - 12 pm

We are ALL vaccinated and seeing patients on our normal schedule. Please call for an appointment. 512-640-4090