If you are an existing patient, please specify your appointment needs and we will contact you to verify your appointment. The more information you provide will help us find an appointment efficiently that best suits your request.  Thank you, we look forward to seeing you.

NEW PATIENTS please click here!

 
Requesting   Rescheduling   Canceling
(We require two business days notice for cancellations.)
Name:   (First and Last name)
E-Mail Address:

  
Phone Number: (Best contact number)
Type of Appointment: Cleaning & Exam with Trevi, RDH and/or Jodie, RDH
Dental Treatment Emergency
(Please describe your needs if requesting treatment or emergency.)
Our Office Hours: Tuesday & Wednesday 8:00am - 6:00pm 
Thursday 7:00am - 5:00pm
Friday 7:00am - 4:00pm
Current Appointment:
(if applicable)		 Date Time : am pm 
Requested Appointment: Date Time : am pm 

Morning and evening appointments are the most popular, please specify all your available days and times if your first choice is not available. If you do not need a specific date and time, tell us what is convenient for you, i.e. days of the week, am or pm and range of dates.  
Called for Cancellation:

 Yes No 
(By checking yes, you will be called when openings become available.) 
Other Requests/
Days of the Week and Times Preferred for Cancellations:

 

*We appreciate you taking care of your own childcare during your visits to our office.

     
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