8350 Fry Rd, Suite 700 Cypress, TX 77433
MiraBella Smiles: Dentist in Cypress, TX
713-376-7444
Book An Appointment
Menu
  • About Us
    • Meet Dr. Winston Faltine
    • Meet the Team
    • Tour our Office
    • Giving Back to the Community
    • Dental Technology
    • Blog
  • Cosmetic
    • Smile Virtual Consultation
    • Dental Veneers
    • Teeth Whitening
    • Invisalign
    • Propel Orthodontics
    • PRF Procedure
    • Dental Implants
    • Smile Makeovers
  • General
    • Emergency Dental Care
    • Root Canal Treatment
    • Sedation Dentistry
    • Implant Supported Dentures
    • TMD/TMJ Treatment
    • Sleep Apnea & Snoring Treatment
    • Wisdom Teeth Extraction
    • Custom Mouthguards
  • New patient
  • Showcase
    • Smile Gallery
    • What Our Patients Say
  • Patient Info
    • Patient Forms
    • Financial Options
    • HIPAA Patient Privacy Practices
  • Contact

Patient Forms

Click on the links to download our New Patient Forms.

  • New Patient Welcome Form (English)
  • New Patient Welcome Form (Spanish)
  • Sleep Apnea Form
  • Photography Agreement and Release Form
  • HIPAA Acknowledgement Form
  • HIPAA Notice of Privacy Practice

SMILE VIRTUAL CONSULTATION

Top Features are:

  • Convenience
  • Discreteness
  • Know what's available right then and there
  • Don't waste your time or money - It's a FREE consultation
  • We have the technology
  • It's a digital scan - no mess.

  • 1. Upload a Photo Below

  • 2. Tell us what you'd like changed

  • 3. We'll send you a video response

1. Upload a Photo Below

We want this process to be EASY! Upload an existing photo from your phone or take a quick selfie. Here are some examples:



2. Tell us what you'd like changed

3. We'll send you a video response

By checking the box on the contact form, you agree to the Terms of Use listed here:

Communications through our website or via email are not necessarily encrypted and are not necessarily secure. Use of the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use.

By checking this box you hereby agree to hold Smile Virtual Consult, its doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.
Please Wait for Sometime File is been Uploaded..

BOOK AN APPOINTMENT WITH CYPRESS DENTIST

Office Hours

  • Monday 9am - 6pm
  • Tuesday 9am - 6pm
  • Wednesday 9am - 6pm
  • Thursday 9am - 6pm
  • Friday 8am - 12pm
  • Saturday By appointment only
713-376-7444
8350 Fry Rd, Suite 700 Cypress, TX 77433
Book An Appointment
Call Now : 713-376-7444