Schedule an Appointment

IF THIS IS A MEDICAL EMERGENCY, PLEASE CALL 911

281-317-6881

New Patient Form

All new patients are required to fill out a “New Patient” form when visiting Space Age Smiles. Feel free to print and fill out the “New Patient” form before your visit for quicker registration.

OFFICE HOURS

Monday & Wednesday: 8AM–5PM
Tuesday & Thursday: 8AM–3:30PM
Friday – Sunday: Closed
281-317-6881

Complete the form below and then click on the “Submit Appointment Request” button.

PATIENT INFORMATION

    Name *

    Email Address *

    Telephone Number *

    Brief reason for appointment *

    HOURS

    Monday & Wednesday: 8AM–5PM
    Tuesday & Thursday: 8AM–3:30PM
    Friday – Sunday: Closed
    281-317-6881

    Schedule an Appointment

    LOCATION

    1020 Bay Area Blvd
    Suite 238
    Houston, TX 77058

    Directions