Appointment Request Form

The first step toward achieving a beautiful, healthy smile is to schedule an appointment. To schedule an appointment, please complete and submit the request form below or click on the Book An Appointment button. Our scheduling coordinator will contact you soon to confirm your appointment.


  • Please note this form is for requesting an appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly by calling 602-866-9704.

    If you are experiencing a dental emergency or do not see an appointment type or time that works for you please call the office at 602-866-9704.

  • Please note that the date and time you requested may not be available. We will contact you to confirm your actual appointment details.

  • This field is for validation purposes and should be left unchanged.