Appointment Request & Mail Form

Emergency Appointments

We offer our patients a same-day appointment for emergency care, providing they call early in the day.

If an emergency occurs on a weekend or after hours, call - (623) 848-0100 - you’ll hear a message telling you how to reach the doctors directly.

DO NOT use the email form for an emergency.

Appointments

During office hours please call (623) 848-0100 to speak with a receptionist.

If you have questions about dental insurance and/or dental financing, or have not yet completed a new patient form, we have NEW PATIENTS information under our menu. Please call with any questions you may have.

Appointment Call-back Form

NOT for cancellation, emergency or solicitation.
Please call: (203) 377-0638 for cancellation or emergency request.

Request an appointment scheduling call.

Name:
Phone:
E-Mail: Are you currently a patient? Yes No If not, how were you referred to our practice? Best Time of Day to Call You Back: Preferred Appointment Day & Time of Day: Comments:

Complete the ANTI-SPAM challenge: