Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. If you are a patient of record, please complete the appointment request form below and we'll respond within 48 hours.

If you are a new patient, please start here.

Please do not use this form to cancel or change an existing appointment. If you need to cancel or change an appointment, please call our office. 


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.

ACCESSIBILITY