Appointment Form Appointment Request Form Please use this form to request an appointment. Contact InformationName First Last Email* PhonePreferred Method of ContactEmailPhoneAppointment SchedulingRegular Appointments are only available Monday-Thursday, 7am-2:30pm. Limited late appointments are now available by special request. Date Time7:00AM7:30AM8:00AM8:30AM9:00AM9:30AM10:00AM10:30AM11:00AM11:30AM12:00PM12:30PM1:00PM1:30PM2:00PM2:30PMReason for AppointmentPlease check the box(s) to indicate if you are interested in these services: Cleaning Tooth Problem/Pain Sedation Dentistry Nitrous Oxide (Laughing Gas) Cosmetic Dentistry (Whitening, Veneers, etc) TMJ, Tooth Grinding/Clenching, Migraines Botox and Dermal Filler Cosmetic Dentistry Lift and Smoothing Threads Facial Esthetics Advocare Dental Nutrition New patients can now download and fill out all forms prior to arrival at our office. CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.