Request A New Dental Appointment

Use this page for requesting a new appointment. If you need to re-schedule, please give our office a call at: 704.364.7069.

These Are The Hours Our Dental Office Is Open
Monday	Tuesday	Wednesday	Thursday	Friday
7:30 AM - 4:30 PM	7:30 AM - 4:30 PM	7:30 AM - 3 PM	7:30 AM - 3 PM	CLOSED

Are you one of our patients? Yes, I am a current patient No, I am a new patient Briefly explain your needs: (check-up, consultation, etc.) Select preferred day(s) of the week for appointment: Monday Tuesday Wednesday Thursday Friday Select the time of day you prefer for your appointment: Anytime Morning Noon Afternoon
Please provide your contact information: *required fields
*Your name:
*Phone number:
*Email address:
Best time to call you:
By whom or from where were you referred? Send your request:
Appointment requests are answered promptly; usually in less than 24 hours. Sending this form is simply a request for a dental appointment. You are not financially obligated in any way. Our office observes HIPAA Federal regulations that protect your privacy. We will never release any information about you without your consent. We are allowed to release information to your insurance company, or as necessary to get paid for our dental services. You can always have access to your patient records simply by asking us.