To request an appointment online, please fill out the form below. Click the “Submit” button to send the request.  If you prefer to make an appointment by phone call us at 208-237-2462. Thank You!

Name:

Email Address:

Patient Name (if different than above):

Phone Number - Home:

Phone Number - Work:


Preferred Day Of The Week:
    Mon     Tue      Wed      Thur

Preferred Time Of Day:
   AM       PM

Reason for Appointment (please be as specific as possible):


How Did You Hear About Us?  If you are a new patient or referral we'd really like to know.

Please review the information you are about to submit for accuracy.
--Thank You!

 
     
 
     
     
     
   

    © Jason Mauseth, DDS, PC - All Rights Reserved