We are happy to accept appointment requests online.  A more simplified online form will be available soon.  If you would like to submit an appointment request please click the button below and include the following information in the email:

1. Name

2. Phone Number

3. Email

4. Date of Birth

5. SSN

6. Insurance information (carrier, group/policy#)

7. Employer

8. Service requested (comprehensive exam, limited exam for tooth ache, etc.)

9. Primary and secondary dates and times.

The information you provide will help us prepare your visit.  If insurance information is submitted we will attempt to verify your benefits prior to your visit.  We will do our best to reserve your primary date and time and make a return phone call to confirm your appointment.