Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. If you know a time and date that works for you, use our ONLINE SCHEDULING TOOL


If you would like our office to contact you to make an appointment, complete the appointment request form below. Our scheduling coordinator will contact you to gather information.

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

*Items in bold are required.
Are you a current patient?

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.