Change Address

Please, fill out the form below to change your address. Once we've called to confrim, we will update our records with your new information. If you would prefer to change you address verbally, please call us at 920 921 0440 or stop by the office.

Patient Information

Change Address for: Individual  Entire Family 

Name :  First  M.I.  Last 

Date of Birth :  mm/dd/yyyy 


Address Information

Previous Address :

Address   Apt/Suite 

City  State    Zip 

Telephone :  920 921 0440  E-mail 


New Address :

Address   Apt/Suite 

City  State    Zip 

Telephone :  920 921 0440  E-mail 
make an appointmentcontact
Family & CosmeticAbout Scholz DDSBecome a PatientFor our Patients
AppointmentsChange AddressTell a friendComment card