Appointment Request

The first step towards a healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. A team member will contact you to confirm your appointment.

 Insurances that we currently are in-network with are: Delta Dental Premier & Ameritas. We also accept any private care insurance plans that allow you to “go out of network”(allows for “out of network” benefits).  Our office does not accept CareSource or any other state funded dental plans at this time.

Please do not use this form to cancel or change an existing appointment.

Items in bold are required.
Are you a current patient?
Best time(s) to call?

Which office location(s) would you prefer for your appointment?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.