Appointments 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.Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!NamePhone*Email* Preferred Date* Date Format: MM slash DD slash YYYY Preferred TimeMorningAfternoonEveningPatient Type*New PatientFollow up VisitReschedule VisitNew Patient SpecialChild Exam X-rays & Cleaning $69 (Ages 12 & under)Adult Exam X-rays & Cleaning $99Emergency Exams & X-rays $49Nature of VisitHow did you hear about us?GoogleFacebookInsuranceReferralCommentsThis field is for validation purposes and should be left unchanged.