Welcome to your E-School LIVE Patient Application/Referral Form

Thank you for your interest in being a patient for a future E-School LIVE session! Please complete the application below so that we can determine how best to serve you.

Please keep in mind this program is for Root Canal Therapy only and there are exclusions that may prevent you from being accepted in the program. Eg, no second molars (first molar to first molar only), no retreatments, no teeth with existing crowns, no small children, no pregnant patients.

If your application is accepted, we will appoint you to see if you are a candidate for the program. Not everyone who fills out an application is a candidate.

First & Last Name
Email
Phone Number (optional)