Home » Request Appointment Make an Appointment Today!Request an Appointment 24/7 First Name Last Name Email Phone/Mobile I prefer to be contacted via: Phone Call Text Message EmailI am a: New Patient Current PatientWhat is the reason for your appointment?* Cleaning, Exam and/or Xray Hygiene Appointment Tooth Pain Previously Diagnosed Dental Need Other(Please Specify) First Choice Day of the Week First Choice Day of the WeekMondayTuesdayWednesdayThursdayFridayFirst Choice Time of Day First Choice Time of DayEarly Morning Between 7 and 9:30 AMMid Morning Between 9:30 AM and NoonEarly Afternoon Between Noon and 2:30 PMMid Afternoon Between 2:30 and 6 PMSecond Choice Day of the Week Second Choice Day of the WeekMondayTuesdayWednesdayThursdayFridaySecond Choice Time of Day Second Choice Time of DayEarly Morning Between 7 and 9:30 AMMid Morning Between 9:30 AM and NoonEarly Afternoon Between Noon and 2:30 PMMid Afternoon Between 2:30 and 6 PMPlease include any relevant information or request here. Why did you choose our office? Search Engine (Google) Great Online Reviews Advertisement in Mail Referred by a current patient OtherOther way you heard about us Referral Name Submit Form Do you have a Dental need? Call as at (801) 374-2182 or request an appointment here GET AN APPOINTMENT
