Demographics

Home / New Patients / Patient Forms / Demographics

Demographics

Schedule Your Consultation Today!

Appointments

New Patients

Welcome
Before and After Photos
Dr.’s Wall of Fame
Patient Testimonials
Video Testimonials
Patient Forms
Reference Page

Ask the doctor

Name:*
Email:*
Phone:
Message:
CAPTCHA

Demographic Information

Patient Contact Information
Full Name*
First Name Last Name
Nickname
Date of Birth*
MM slash DD slash YYYY
Gender
- MALE
- FEMALE
Height
Weight
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Work Phone
Cell Phone
Okay to Call You at Work?
- Yes
- No
Employer
Email*
Emergency Contact
Emergency Contact Phone
Family Physician
Guarantor Information
If the patient is the guarantor, there is no need to fill out the information below.
Full Name
First Name Last Name
Nickname
Date of Birth
MM slash DD slash YYYY
Gender
- MALE
- FEMALE
Height
Weight
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Work phone
Cell Phone
Okay to Call at Work?
- Yes
- No
Employer
Email Address
Emergency Contact
Emergency Contact Phone
Family Physician
CAPTCHA

After submitting, feel free to return to the Patient Forms page. Please note, there are multiple forms for each section.

Schedule Your Consultation Today!

(801) 298-1812

Schedule Your Appointment with the Holistic Dentist

Every service we offer is aimed at improving your overall health. We offer several procedures that eliminate the need for surgical incisions, reducing your discomfort, downtime, and the need for multiple visits. Call our office to schedule your consultation today.

Appointments

Our office

Dental Solutions, Inc
Dr. Judson Wall
235 S 400 E
Bountiful, UT
84010
Phone: (801) 298-1812

About Our Practice

Meet Dr. Wall
Meet The Staff
Patient Testimonials
Before and After Photos
Financial Policy
Office Directions

Featured Treatments

Mercury Free Dentistry
Root Canal Removal
Cavitation Surgery
Pinhole Surgical Technique
Zirconia Dental Implants
Digital Impressions
CARESTREAM
One Visit Crowns

Dr Montes seen both of my kids and was absolutely amazing, they felt no pain, very comfortable the whole time. They loved it there! They were both scared to go and now they both can't wait to go back!

Kierston Kirby

May 24, 2022.

I feel very fortunate to have found Dental Solutions. The dentists and the staff are outstanding! I have had health issues for many years and had this underlying, nagging feeling that was just exhausting. I went to Dental Solutions and had cavitation surgery and other dental work clean up, and that underlying nagging feeling is gone and my energy has returned! I would highly recommend them.

Tina Clifford

June 28, 2021.

The doctors and supporting staff are wonderful, and have helped me take control of my health through corrective dental work. It’s so nice to have a consultation with professionals who really care about you and your life!

Bonita Richins

June 18, 2021.

Dr Montes is a very knowledgeable dentist, and the whole staff is very fun and professional.

Coz

June 14, 2021.

The doctors and staff at Dental Solutions are exceptional. I have been going since 2015 and have received the best of care. Dr. Wall is a great dentist with much knowledge and expertise. He and the staff make sure you are comfortable and have all your questions answered. Kris is the best and most thorough hygienist. Highly recommend!

Marianne Austin

June 2, 2021.

Dr. Wall is a living legend in our family! He has helped me recover from poorly done root canals, fixed years worth of incorrect orthodontics, and solved my TMJ problems. I struggled with chronic vertigo during and after my pregnancy that was passed off as “normal” hormonal changes. I saw multiple doctors and neurologists before visiting Dr. Wall. He discovered 4 cavitations that needed addressing and once he worked his dental magic, the vertigo I had struggled with daily for 2 years disappeared! The importance of proper dental care for overall health cannot be overlooked. Dr. Wall is the best in his field and it’s an honor to have him on my healthcare team!

Missy Beavers

May 26, 2021.

I highly recommend Dr. Wall to anybody with tooth aches or pains. He is so caring and understanding. He has genuine concern for my well being. His staff is very nice and professional. I can't say enough good things about the care I received from Dr. Judson Wall and his team. Thank-you!

Tyler Heath

May 26, 2021.

I had so much discomfort for years and Dr Wall took out teeth that were gangrene that I did not know were that bad. He is amazing....

Beatrice Ireland

May 24, 2021.

Hands down the most amazing dentist I've ever been to. From the expertise of care and heartfelt communication from Dr. Wall and his staff to the lush jungle of plants throughout the office, this is a dental experience like no other. For 15 years I had been struggling with a phantom disease causing chronic fatigue, brain fog, anxiety, depression, etc...it was hell. A woman (who I now feel is certainly a guardian angel) brought to my attention that my story was almost identical to the man who produced the film "Root Cause". I was taken aback that my issues could actually be caused by an old root canal I had and felt compelled to watch it...it made me cry and I knew this was it. She then referred me to Dr. Wall and the rest is history. I spent about 4 hours at Dental Solutions my first visit where I received a level of care you wouldn't expect from a dentist, let alone your family doctor. Being a biological practice, Dental Solutions has your whole body in mind and I was tested from head to toe to figure out what was going wrong. Sure enough, I had a failed root canal that had eaten a 1 cm diameter hole in my jaw above that tooth...it was slowly killing me. Dr. Wall pulled the decayed tooth which was gangrenous, cleaned everything out, stuffed the decayed hole with platelet rich fiber (PRF) and put a zirconia implant in. He also cleaned out my wisdom tooth cavitations and did TMJ injections to help the jaw issues I didn't realize I had. Over one year later and I feel better than ever, I have my vitality back!!!! So very thankful for Dr. Wall, he saved my life. No other dentist had any idea what was going on. This is the place to go, I travel from Colorado to come here...highly recommend this practice. Thank you Dental Solutions for changing my life!

Alex Curry

May 13, 2021.

Reviews

235 South 400 East, Bountiful, Utah, 84010