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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 scheduling coordinator will contact you to confirm your appointment.

Office Hours:

Monday: CLOSED

Tuesday: 8:15am-3:45pm

Wednesday 9:00am-5:00pm

Thursday 8:00am-4:45pm

Friday 9:00am-4:45pm



Please do not use this form to cancel or change an existing appointment. This office requires 3 business days notice for cancelling or rescheduling appointments and we ask you call during office hours to speak with our receptionist.


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.