Make an Appointment To schedule a complimentary exam to see if orthodontic treatment is right for you, please call 207-797-5577 or fill out the form below. Patient Name* First Last Parent/Guardian Name First Last Will this be your first visit to our office?* Yes No Phone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Birthdate Dentist Preferred Days Preferred OfficeAnyPortlandWindhamSouth PortlandBuxtonConvenient Times How did you hear about our practice?AdvertisementA friendDentistPatientFamily MemberStaff MemberYellow PagesFacebookSearch EngineOther InternetOtherWho was it you heard about our practice from? Other Comments or QuestionsCommentsThis field is for validation purposes and should be left unchanged. Δ
