Patient Forms
Learn more and request your appointment below!
Patient Forms
Please fill out the forms on this page and bring them to your first appointment! If you have any questions, don’t hesitate to reach out to our friendly team.
Your smile is one of your most valuable assets, so you need a dentist you can trust to take great care of it. You need a professional who has confidence, integrity, and the advanced skills needed to make your smile healthy and beautiful.
You can always feel comfortable and secure putting your confidence in Dr. LoSasso and his caring team at Brevard Smiles. The moment you arrive at our dental offices in Indian Harbour Beach and Rockledge, Florida, you will be greeted as a true friend and neighbor, and will receive the highest quality and most customer-centered care possible – responsibilities we take very seriously.
We strive to...
Treat you the same way we like to be treated
Educate ourselves by taking continuing education courses
Invest in the modern technology and supplies
Challenge ourselves and our team to be the best
Insurance & Billing
Attaining the smile you’ve always wanted is as important to you as it is to us, and helping you affordably achieve that smile is our main goal. Our qualified financial team will do everything to ensure that expense does not prevent you from receiving the quality care you need and desire. Please contact our friendly staff to learn more about Insurance & Billing.
Why Choose Our Practice
Kind & Hospitable
With premier dental services, a comfortable environment, and neighborly care, Dr. Varela & Dr. Diaz want to help make those remarkable moments in your life shine brighter with your smile.
Flexible Financing Options
Our qualified financial team will do all it can to make sure that expense does not prevent you from receiving the quality care you need and desire. We have developed different financial options to help you facilitate your goals.
Convenient Location
We serve the great people of our community with a centralized location in Orlando. We look forward to providing you with the top-of-the-line, progressive dental care and customer service our patients have come to expect.
We Love Our Patients!
We are so thankful to have such amazing patients who have taken the time to share their experiences on Google, Facebook, and other online sources.
Contact our Friendly Staff Today!
Monday: 8:30am - 4:30pm
Tuesday: 8:30am - 4:30pm
Wednesday: 8:30am - 4:30pm
Thursday: 8:30am - 4:30pm
Friday: 8:30am - 4:30pm
Saturday: Closed
Sunday: Closed
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