Request An Appointment

If you are an existing patient and have an emergency during clinic hours, please call the clinic directly for assistance. For emergencies after clinic hours, please do not submit a request on this page, but instead please fill out the teledentistry forms on our EMERGENCIES page, reading all directions completely.

Parent's Name:(Required)
Type of Appointment:(Required)
Office Preference:(Required)
This field is for validation purposes and should be left unchanged.