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Want to pay online?

Did you receive a statement but want to pay online? Please fill out the form below and we'll text you a link to pay!

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NEW PATIENTS

Are you a new patient? Print out and email us a copy of the registration form to: themoderndaydental@gmail.com, or simply fill one out online HERE. Call us to schedule an appointment at (408) 246-3566.

X-RAY RELEASE

Do you need your x-rays sent to another location? Print out and email us a copy of the x-ray release form to: themoderndaydental@gmail.com, or simply fill one out online HERE.

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