New Patient Booking

Selected Office:

Space City Orthodontics - Houston Clear Lake

Dr. Vijay Bhagia, Dr. Lina Aljoudeh

1140 Clear Lake City Blvd Ste C Houston, TX, 77062-8128

(281) 286-8945

New Patient Information

Let's get you booked!

Already in Treatment: If you're a current patient - or transferring to our clinic to continue treatment - please call us at the number above to book an appointment.

First-timers, start here: Your free consultation awaits! Please complete the form below to get it on the books.

Patient First Name*

Patient Last Name*

Patient Date of Birth*

Are You the Patient?*

Cell Phone*

Address *

Address 2 (optional)

City*

State*

Zip*

Email Address*

One Last Question, Please...

How did you hear about us?*

I have read, understood and agree to the HIPAA Notice.

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