CoupleKLR - Dental

Contact

Telephone
540-904-4644

Hours

Monday:

7:30 am - 5:30 pm

Tuesday:

7:30 am - 5:30 pm

Wednesday:

7:30 am - 5:30 pm

Thursday:

7:30 am - 1:00 pm

Friday:

8:00 am - 4:00 pm

Location
Dr. Michelle Mayerchak, D.M.D.
4207 Colonial Avenue S.W.
Roanoke, VA 24018


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To make an appointment, schedule an oral cancer screening
or get a FREE smile makeover consultation, please fill in our inquiry form below.

General details

* indicates required information
First Name *
Lirst Name *
Email
Telephone *
Cell phone
Address 1
Address 2
Zip code *
Are you interested in:
Getting a FREE smile makeover consultation?
Gum Disease screening?
Invisalign?
General checkup?
Are you interested in making an appointment for another member of your family?
Name
Name
Name
Additional information:

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. The privacy of your health information is important to us.

New Patient Forms

To save time, you can print and fill out our new patient and medical history forms before you come to our office on your first visit. Please print the forms below, fill them out and bring them with you for your appointment.

After reading the Notice of Privacy Practices, print the Acknowledgement form below, sign it and bring it in, too.

New Patient Form

Medical History Form

Acknowledgement of Receipt of Notice of Privacy Practices