Appointment Request

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 confirm your appointment.

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

*Items in bold are required.

Name:

Are you a current patient?
 Yes No

Address:

City:

State/Province:

Zip/Postal:

Email:

Phone:

Best time(s) to call?
 Morning Noon Afternoon Evening

Preferred day(s) of the week for an appointment?
 Any Day Monday Tuesday Wednesday Thursday Friday

Preferred time(s) for an appointment?
 Any Time Morning Noon Afternoon Evening

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

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No Dental Advice Intended. This website includes general information about dental issues and the practice of dentistry. Such materials are for informational purposes only and should not be considered dental advice. Information found on this site may not reflect current dental standards. For dental advice specific to your needs, contact a licensed, practicing dentist. Do not rely on any statements contained herein. The information contained in this website is for informational purposes only. It is not, nor is it intended to be, dental advice. Your review or use of this web site, its information and links does not create a dentist-patient relationship or a dentist-patient privilege between this practice and you. Statements made to us before the formation of a dentist-patient privilege w may not be privileged and confidential.