accessibility ACCESSIBILITY
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 office staff will contact you to schedule your appointment based off the times requested if available. 

Office Hours:

Monday 8:30am - 5:45pm
Tuesday 7:45am - 2:00pm
Wednesday 7:00am - 3:00pm
Thursday 7:45am - 2:00pm

**PLEASE NOTE - Office hours are different than Appointment hours. The last appointment for everyday is scheduled 1 hour prior to closing. Feel free to give us a call with any questions about scheduling.**

Please do not use this form to cancel or reschedule an existing appointment. Those changes must to be made over the phone to avoid a no show fee.


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.