Please complete the following form to request an appointment. Note that availability will vary depending on your request. A member of our staff will be contacting you within 2-3 business days to speak with you about your appointment request.

Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.

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This form should NOT be used for dental emergencies. If you are experiencing a dental emergency, please call our office at (262) 255-4343.