Request An Appointment

Some appointments are not available online. Please complete the form below and we’ll give you a call.

First Name* Last Name* Phone Number* Preferred Date* Email Address*

I have an emergency

I have insurance

I am a returning patient

I need multiple appts

How Can We Help?

We're sorry. There has been an error while trying to submit this form. Please reload the page and try again.

For a dental emergency, please call us at 623-476-5820.