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Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Your scheduled appointment time has been reserved specifically for you. Our office requires 48 - 72 hour notice if you need to cancel or reschedule your appointment. We are aware that unforeseen events may happen which require you to miss an appointment, that will be taken into consideration. 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.

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.

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