New Dental Office Requests

Connect With Our Team

We are so glad that you are interested in beginning anesthesia services with ELITE Sedation! Please fill out the form below to the best of your ability and our team will reach out to you as soon as possible.

Please fill out the name found on Google. If the office has multiple locations, please format like this: [Office Name] - [City]
e.g. Lollipop - Cerritos

Please print first and last name only. If this person is a Dr., please include the Dr. title.

Please select the option most fitting to your role.

Please format in this way: XXX-XXX-XXXX

Please select the option most fitting to your role.

Please select the option most fitting to your role.

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Locations We Serve

Professional guidance on sedation care and safety

Insights & Education