Are you new to Kool Smiles? Registering your family and selecting appointments is easy!

Fill out the form below to get started

Choose a Location
Parent or Guardian Information
Insurance Information
Information for Patients seeing the dentist
Enter your zip code to find a location near you:

Tell us about yourself—the parent or guardian
Please enter your first name
Please choose your Parent/Guardian Last Name
Please enter your email address
Please enter your date of birth
Please choose your gender
Please choose the Street Address
Please choose your City
Select State
Please enter your zip code
Choose Language
Tell us about your Dental Insurance:

Note: Insurance information is not required to register your family.

Tell us about the person who will be seeing the dentist
Appointments may be made for individuals under 21 years old
Please bring a clearance letter from the patient’s doctor at the time of your appointment.
Tell us about the Patient's Dental Insurance:
Please choose two appointment days and times:
For your convenience we are showing the first available date below
First Choice
Second Choice
Would you like to add another child or patient?
Please review your information. You can make edits, or complete your family’s registration below.
Parent or Guardian Information
Information for Patients seeing the dentist

Welcome to the Kool Smiles Family!

We can’t wait to meet your family. So what’s next?

You'll receive an email shortly to confirm your selected appointment. If we have any questions about your information, we'll contact you at the number provided.

Important: If you have not provided full insurance information, please call us at 888-699-1899. We need information before your appointment!

Need to schedule an appointment for an adult? Give us a call

Once we create your account, you can register for the patient portal to fill out forms ahead of time and see your appointment details!

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