Book an Appointment

    Hershey Dentist – Bhargav Patel, DMD - Family, Cosmetic and Implant Dentistry

    The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

    Please do not use this form to cancel or change an existing appointment.



    575 E.Chocolate Ave HERSHEY, PA 17033

    Any DayMondayTuesdayWednesdayThursdayFriday


    Note:   Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

    • header
    • header2
    • header3
    • header4
    Book an Appointment

    Patient Registration

    • Patient Is:
    Responsible Party (If someone other than the patient)
    Patient Information
    • Sex:
    • Marital Status:
    • Section 2
    • Employment Status:
    • Student Status:
    • Section 3
    Primary Insurance Information
    • Relationship to Insured:
    Secondary Insurance Information
    • Relationship to Insured: