Appointment Request

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

Have a general inquiry or need to schedule a different appointment? Fill out the form below and we will be in touch shortly.

Contact Us

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