• Gentle and Advanced Dental Care
• Dental Services & Offerings
• What is a Dental Hygienist?
• Meet the Dentists
• Meet the Dental Staff
• Ask the Dentists Questions
• Make a Dentist Appointment

Make an Appointment

Appointment Request Form

Please fill out the form below, and be sure to print and fill out a family medical history form.

* - Indicates required fields
First Name:*
Last Name:*
Address:
City:
State:	Please select Alabama Alaska American Armed Forces Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pacific Islands Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas US Virgin Islands Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Email:
Daytime Phone Number:*
How Soon Do You Need The Appointment?:	ASAP Within a week Within two weeks Within the month
Reason for Appointment:*
Note: If this appointment is for a dental emergency, please call us at 800 362 3980

 

Attention New Patients

As a new patient you will be asked to complete a family and medical history form. Please download and print out the file below:

Health History Form - PDF File

Any medications you may be taking or allergies you may have are extremely important to us. This information is held in strictest confidence and is necessary to assure you the best possible dental care.

Generally your first appointment (except in the case of an immediate problem) will include a comprehensive examination of the teeth and soft tissues of the mouth. Any necessary radiographs (X-rays) will be taken at this visit in order to develop a complete diagnosis. After this diagnostic information has been evaluated, we will then be able to provide you with a propose treatment plan and fee estimate.

Future appointments will then be scheduled for the appropriate amount of time necessary to provide you with optimal dental health care.