ACCESSIBILITY

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to schedule an appointment based on your preferred appointment time.

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

 

**Please review our Broken Appointment Policy.  We require 48 notice if you must change/cancel your appointment in order to avoid a broken appointment charge. 

 

 


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.