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!

We now offer ONLINE appointment booking for your convenience! If your preferred appointment time is not available through our online scheduler, please complete our Appointment Request Form below and our office will contact you to schedule your appointment.


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 *