Contact Us : Make An Online Appointment

If you are a new patient, then you can save time by downloading our Dental Form and completing it at your convenience. Just bring the completed form to our office on your first appointment.

	Welcome Form
	Consent Form
	Evaluation Form

You can now schedule an appointment online. Fill in the required fields below and someone will contact you within 48 hours to confirm or reschedule your appointment. Please allow one week for appointments. Our family dentistry practice is open to patients of all ages.

EMERGENCIES - emergency care is available on short notice. Please call our office for information.

* indicates mandatory fields
Name:*
Street Address:
Address (Cont):
City:
State/Province:
Zip/Postal Code:
Work Phone:
Home Phone:*
E-Mail:*
Age:
Sex:	Male Female
	Reason for Appointment:* General X-Ray and Cleaning Toothache / Emergency Cosmetic Dentistry (Bleaching, etc.) Other
	Date for preferred appointment (DD/MM/YY):*
	Time for preferred Appointment:*
	Other information:
	Please enter the two words below into the provided text box. (you may choose another set of words if necessary)