Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please know one of our staff members is always awaiting an opportunity to talk with you and help you with your needs. On our busy days, the best way to contact us is by phone, so don't hesitate to call!

If you prefer, complete the contact form below and one of our staff members will call you to schedule 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.