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?*YesNoPhone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code BirthdateDentistPreferred DaysPreferred OfficeAnyPortlandWindhamSouth PortlandBuxtonConvenient TimesHow did you hear about our practice?AdvertisementA friendDentistPatientFamily MemberStaff MemberYellow PagesFacebookSearch EngineOther InternetOtherWho was it you heard about our practice from?OtherComments or QuestionsEmailThis field is for validation purposes and should be left unchanged.
