SOTA Dental Scheduling Form This is our scheduling form. Only use this form if you have no questions at this time and would simply like an appointment with our doctors. Once you send your appointment request, a member of our team will call you to confirm your date.If your have questions about treatment plans or prices, please use our other PATIENT FORM.All of your information is confidential and only shared with our doctors and patient managers.Step 1 of 333%Which SOTA Dental location would you like to request an appointment? Cancun Playa del Carmen Los Algodones TijuanaWhat date would you like an appointment? Date Format: MM slash DD slash YYYY What time of the day is best for you?* Morning Afternoon Evening Does not matter Name* First Last D/O/B*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex* Male FemaleWhere are you traveling from?AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCanadaMexicoOther Email Address (for private information)*Please provide your email address for receiving medical information. SOTA Dental uses email to send private information related to your case. Please supply an email address that you feel comfortable receiving dental information with. Enter Email Confirm Email Phone Number*Please choose the best phone number to receive an appointment confirmation call on.Which option below below best describes your dental situation? I am in serious pain I am interested in the All-on-X procedure I am interested in single dental implants I need restorative dental work due to bad teeth I have slight pain and want it elevated. I want a more beautiful smile OtherBriefly explain your dental situation.Tell us what is going on in your mouth right now.