Request an Appointment

The first step toward achieving a beautiful, healthy smile is to schedule an appointment. To schedule an appointment, please complete and submit the request form below.

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

Privacy Policy

Please download, print, review and sign a copy of our practice privacy policy. Please bring the signed policy to your complimentary consultation. Let us know if you have any questions.

HIPPA Privacy Policy (PDF)

    Patient Name *

    Parent Name

    Email *

    Phone *

    Type of Appointment

    Preferred Date *

    Preferred Time *