*If you are a new patient and would like to schedule an appointment, please click HERE! We strive to remain on time for the benefit of all patients, so we ask that you arrive at least a few minutes before your scheduled appointment. If you are a new patient, please arrive 10 minutes early to complete the necessary paperwork and to allow us time to verify your insurance information. If you arrive late, we will do our best to work you back into the schedule. However, in our effort to keep other patient appointments on time, your wait may be longer. When possible, please let us know if you will be late to your appointment. If you need to cancel or reschedule an appointment, please let us know at least 24 hours in advance. We understand that emergencies happen, and we appreciate any advanced notice you can provide.NamePhone*Email* Patient Birthdate* Date Format: MM slash DD slash YYYY Parent/Guardian Name*Patient Address* Street Address City State / Province / Region ZIP / Postal Code Dentist Name*Preferred Date* Date Format: MM slash DD slash YYYY Preferred TimeMorningAfternoonEveningNature of VisitCAPTCHANameThis field is for validation purposes and should be left unchanged.