Appointment Request

The first step toward achieving a beautiful, healthy smile is to schedule a FREE SMILE EXAM.

No referral is necessary from your dentist so please let us know who recommended you (friend, family member, dentist, etc) so that we can thank them personally!

To schedule an appointment, please complete the form below.

Please note this form is for scheduling a new appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly.

    Patient Name *

    Parent Name


    Phone *

    Type of Appointment

    Preferred Date *

    Preferred Time *