Appointment Request - Tufts Medical Center Residents

This form is specifically for Tufts Medical Center Residents looking to receive dental care at Tufts Dental School. To request an appointment or more information, pleaseĀ fill out the form below. Please do not submit sensitive information through this form.

First Name
Last Name
Request Details
Do you currently have a dentist?
Are you currently in pain?
IMPORTANT! Please do not share sensitive personal information through this form.