To request an appointment, please click on each of the forms on this page and fill them out completely. Then email the forms to us at dryahya@accessdentalcare.com. Please allow 2-3 business days to verify your insurance information and contact you.

If you are experiencing a dental emergency please follow up with a phone call at 301-776-6666 to notify us of the urgent nature of your predicament.

Once we receive the forms, you will be contacted by one of our Patient Care Coordinators to confirm your appointment request.



We find that many of our existing cliental are our best marketers. We would like to reward them for their referrals. If there is someone who has referred you please let us know so that we can grant them their free gift.

• Assignment And Release Form
• New Patient Consent Form
• Medical History Form
• Patient Registration Form