Use the form below to request an appointment with: Leticia Chaves de Souza
*Please note: This appointment request form is for the UT Dentists Group Practice, where the fees are comparable to private practice. If you are interested in the student teaching clinics, please call 713-486-4000.
Please provide the best number to reach you for health-related matters
Please provide the name of your insurance company. If none, please indicate None.
Please provide your Member ID number. If not applicable, please indicate N/A.
Please provide your Group ID number. If not applicable, please indicate N/A.
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