Book An Appointment If you would like to book an appointment, please complete the form below and we will contact you to schedule. Your First and Last Name (required) Your Email (required) Phone Number (required) Your Date of Birth (required) If you are taking any medication- What pharmacy do you go to? If you have any previous x-rays- What office did you have them done at? When and where was your last cleaning? (required) Do you have any bleeding when brushing or flossing? (required) Are you a non-smoker or smoker? (required) Were you referred by a dental office? (required) Your Message
