Appointment Request

Please contact our office by phone or complete the appointment request form below to schedule a pediatric dental appointment  or an orthodontic consultation . One of our team members will contact you to confirm your appointment.

Dear parents we kindly ask that you AVOID using this form to cancel or change an existing appointment. We ask that you call our office so we can assist  you in doing so.
*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.