Contact 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.

If you provide your phone number you agree to opt-in and receive calls and texts regarding your request and future appointments as needed. Message and data rates may apply. Reply “STOP” at any time to opt-out.

 

Monday 9:00am - 5:00pm (Office Open every other Monday)
Tuesday 8:00am - 5:00pm
Wednesday 9:00am - 5:00pm
Thursday 8:00am - 4:00pm
Friday 8:00am - 4:00pm (Office Open every other Friday)


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.

If you provide your phone number you agree to opt-in and receive calls and texts regarding your request and future appointments as needed. Message and data rates may apply. Reply “STOP” at any time to opt-out.