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.  If you are a new patient, please visit our Patient Forms page and complete the New Patient Chart as we will need this form to schedule your initial appointment.  You may submit your New Patient Chart by fax, email, mail or in person.  We look forward to welcoming you to our practice!

Please do not use this form to cancel or change an existing appointment.

If you have a dental emergency, please call our office and follow the instructions given on our voice mail.  Please note that our office closes at 4pm Monday-Thursday and we are not open Friday-Sunday so if you choose to request an emergency appointment via email, we will not be able to address your request until the next business day. 

Each time a patient misses a scheduled appointment without providing proper notice, another patient may be prevented from receiving access to care. Therefore, our office reserves the right to charge a $25 fee for all appointment which, absent a compelling reason, are not cancelled at least 24 hours in advance.

*Patients age 55 and older should bring their current list of medications (includes prescriptions, over the counter medications, and supplements)

*Please feel free to bring your Ipod to listen to during any of your dental appointments or if you have a lengthy dental procedure scheduled and would like to bring your own DVD to watch, you are more than welcome to do so. 

Office Hours

Monday - Thursday     7:30am-4:00pm

Friday - Sunday          CLOSED


*Items in bold are required.
Are you a current patient?

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.