Request an Appointment

The first step toward achieving a beautiful, healthy smile is to schedule an appointment. To schedule an appointment, please complete and submit the request form below.

Please note this form is for requesting an appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly.

New Patients: click here to schedule your free smile exam online!

 

    Patient Name *

    Parent Name

    Email *

    Phone *

    Type of Appointment

    Location *

    Preferred Date *

    Preferred Time *

    Comments