Appointment Request

Your fastest option for scheduling cleanings, emergencies, and consultations. New patient specials are still applied.

Need to schedule a different appointment or have a general inquiry? Complete the form below and we will get back to you shortly.

Your fastest option for scheduling cleanings, emergencies, and consultations. New patient specials are still applied.

Need to schedule a different appointment or have a general inquiry? Complete the form below and we will get back to you shortly.

Name*
First Last
Email*
Phone*
Preferred Location*
Have you been to the office before?*
- New Patient
- Existing Patient
Appointment Type
- Regular Cleaning
- Other Procedure
Preferred Date
Format: mm/dd/yyyy
Date Format: MM slash DD slash YYYY
Time
- Morning
- Afternoon
- Send me the new patient specials: $59 cleaning, $19 Exam, Free Take-Home Whitening
Message
Phone
This field is for validation purposes and should be left unchanged.