Appointment Request

The first step towards restoring a beautiful, healthy smile is to schedule an appointment. Two (2) convenient locations are at your disposal. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

 

We are very concerned for your safety and well being. Should you need to be premedicated with antibiotics before dental treatment, for reasons such as artificial joint replacements or heart valve replacements etc, please notify us at the time of making an appointment.

 

Please do not use this form to cancel or change an existing appointment.


Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.