• This field is for validation purposes and should be left unchanged.
  • What to bring to your first appointment:

    • Photo ID
    • Insurance Card (for those w/dental
    • insurance) List of Medications and Questions
    • Concerns and Hopes for your smile.
    Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.

    Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!
  • MM slash DD slash YYYY