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Drs. Annie Freedman & Jackie Galvez
Pediatric Dentistry
Dr. Robert Spoont
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Dr. Arthur Kapit
  Orthodontics
Appointment Request

To request an appointment, please fill out and submit the form below. Then, we will contact you to make the necessary arrangements for your appointment.

Please note this request form is for non-urgent appointments only. If you have a dental problem that you feel requires more urgent attention please contact us directly by phone.

Full Name
Address
Day-Time Phone Number
Alternate Phone Number
Email Address
I would like to (choose one):





Are you currently a patient with us?



If you are a new patient where did you first hear about the practice?






Other, Explain:

Additional Information

Verification Code (case sensitive):

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    Freedman, Spoont, Kapit, and Associates, Big Tooth Fan Club
21301 Powerline Road, Suite 208, Boca Raton, FL 33433   
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