Madison 608.274.5970
DeForest 608.846.3302

PAY MY BILL REQUEST APPOINTMENT

Madison | DeForest | Appointment Request

Dentist Referral Form for New Patients

Patient Information
Patient Name*
First Last
Name of Parent/Guardian if Patient is a Minor
First Last
Primary Phone*
Birthday*
Date Format: MM slash DD slash YYYY
Preferred Clinic*
- DeForest
- Madison
Referred By
Doctor*
Clinic*
Phone*
Email*
Patient Information
Date of Last Exam*
Date Format: MM slash DD slash YYYY
Date of Last Cleaning*
Date Format: MM slash DD slash YYYY
Date of Most Recent Bitewings*
Date Format: MM slash DD slash YYYY
Date of Most Recent Panoramic/Full Mouth Series of X-Rays*
Date Format: MM slash DD slash YYYY
File Attachment (X-Rays, Notes, Letters or Other)
More Details or Comments
Comments
This field is for validation purposes and should be left unchanged.

Cosmetic
Dentistry

Pediatric
Dentistry

Family
Dentistry

Geriatric
Dentistry

Periodontal
Dentistry

Snoring &
Sleep Apnea

Restorative
Dentistry

Please request an appointment online for a dental treatment consultation with one of our dental professionals.

REQUEST APPOINTMENT

ONLINE PAYMENTS

Madison Family Dental

4.9 - 97 Google Reviews

Marsha Lichte-Crow9/20/2018

I’ve been a patient at Madison Family Dental for over 30 years, so obviously this will be a positive review! Dr. Challenger and his hygienist, Doris, are both very personable and kind. Highly recommended.I also appreciate the evening hours as I work full-time and do not have a flexible schedule.

Ed Peirick5/20/2019

My longtime dentist recently retired but I never had any concerns about the change. I now see Dr. Challenger and was very impressed with his communication and care. Madison Family Dental has served me well for over 30 years!

James Rossing6/20/2019

Dr. Wirtz and Tayler are incredible. Provide the best care and always make you feel welcome!

psbassett .9/20/2018

Needed a dentist and had no idea, so I picked one who donates dental services to the poor. That turned out to be Dr. Veerman. While I have insurance and a good job, I thought it was an important character statement that someone with such a lucrative skill set would make time to use those skills to help, especially dental treatment because it's expensive and not as well resourced for people without money. My first appt was an evaluation to see what needed to be done, as there was much to do. After the bad news, Dr. Veerman made time for me to come back that same day to fill two cavities. She did it quickly and her Assistant Wendy seemed very efficient and knowledgeable since Dr. Veerman only had to specifically ask for something once. Otherwise, Wendy had every tool, suction, etc. at the ready. Another important point is that I was given a treatment plan which included the charges for each item. The business office was forthright and forthcoming answering questions and explaining the systemic forces regarding insurance and so on. This transparency equates to value for services rendered, as opposed to the angst one might feel over the costs without those insights from the business side of things. I was never rushed or made to feel I was imposing.I'm rating four stars as I've only had one visit so far and the worst is yet to come. So far, so good as to treatment and staff. If only Dr. Veerman would put a muffler on that drill! One thing I did notice was some sort of white floor cleaning residue accumulating around the bases of the cabinetry and flooring cracks. This caused me to look around the facilities more closely and I noted a few other things easy to miss if you are there every day. I'm confident this will be remedied if anyone reads this. I'll post follow-up reviews as my experience evolves.

Becky Hay De Garcia7/25/2019

Dr. Challenger and his team of hygienists are extremely competent and more honest than any dentist I have seen since the 80s. If he discovers a possible issue, he tells the patient what he sees, explains that it may not become a problem for a week or many years, and allows the patient to decide whether to just watch that tooth/area or get it fixed right away. Before I switched to Dr. Challenger, I was told by my dentist that I needed 4 crowns. That was over 10 years ago. Dr. Challenger found no such problems, but after a few years he saw one tooth that needed watching. It was several years later that I actually needed a crown on that tooth. I have never needed another. On Monday this week, I had my teeth cleaned, and Dr. Challenger discovered that a small piece of one of my very old fillings had broken off. I was able to get an appointment the VERY NEXT DAY, to have it replaced!