Patient Form

Please complete this confidential form so we can evaluate your case and prepare your personalized dental travel plan to the Dominican Republic.

Al proporcionar sus datos, usted acepta recibir llamadas telefónicas y mensajes de texto por parte de Odontología Moderna, incluyendo comunicaciones automatizadas, pregrabadas o mediante voz con inteligencia artificial, con fines informativos y de marketing. Puede cancelar estas comunicaciones en cualquier momento respondiendo “STOP” o solicitándolo directamente a nuestro equipo.

I acknowledge that Smile Dental Travel acts as a travel coordination agency and not as a licensed dental provider. All medical procedures will be performed by licensed dental professionals in the Dominican Republic.

Smile Dental Travel LLC helps international patients access quality dental care in the Dominican Republic through a smooth, well-coordinated experience that includes travel support, private transportation, accommodation assistance, and personalized guidance throughout the journey.