Sarasota Orthodontics - Contact Freeman Orthodontics


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Freeman Orthodontics
3300 S. Tamiami Trail, Suite 8
Sarasota, Florida 34239
941.953.7500
Map & Directions | Office Hours

For your convenience there are two ways to schedule your complimentary initial examination: call our office during normal business hours or complete the form below and we will contact you by phone.

Please note all questions specific to your individual dental insurance policy are handled via the telephone only. If you have dental insurance and would like our office to verify orthodontic benefits please be prepared to provide the following information: the name and phone number of the insurance company, the subscriber’s (policy holder’s) name, subscriber’s date of birth and the subscriber’s social security number and the patient’s name and date of birth.

Patient's First Name:
Patient's Last Name:
Patient's Date of Birth:
Response Party's First Name:
Responsible Party's Last Name:
Address Line 1:
Address Line 2:
City:
State:
Zip:
Daytime Phone Number:
Patient's Dentist:
Referred by:
Dental Insurance:		Yes No
Comments/Questions:

Please note all responses will be handled via telephone. Thank you for your interest. We look forward to seeing you soon!

THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT.

Home \| About Us \| First Visit \| FAQ \| Contact Us \| Directions 3300 S. Tamiami Trail, Suite 8, Sarasota, FL 34239 \| Phone 941.953.7500 All material © 2005-2006 by Freeman Orthodontics, All rights reserved. Reproduction in whole or in part is prohibited without the written permission of Freeman Orthodontics