You can now Request an Appointment on-line. If you are a new patient please use the form at the bottom of the page. For existing clients please use the form below. First Name: Last Name: Please fill in at least one of the following Home Number: Work Number: Cell Number: Type of Appointment Please fill in at least one of the following Recare (ie checkup & cleaning) Emergency Continue With Planned Treatment Most Convinant Day Must Check One. Monday Tuesday Wednesday Thursday Friday Saturday Alternate Day Must Check One. Monday Tuesday Wednesday Thursday Friday Saturday Most Convinant Time Must Check One. Morning 8-11 Lunch 11-1 Afternoon 1-4 Evening 4-8 E-Mail: Add me to your e-mail list.     --------------------------------------------------------------------------- New to the Practice? Please use this form. First Name: Last Name: Please fill in at least one of the following Home Number: Work Number: Cell Number: Type of Appointment Please fill in at least one of the following Emergency Introductory Cleaning Complete Examination Most Convinant Day Must Check One. Monday Tuesday Wednesday Thursday Friday Saturday Alternate Day Must Check One. Monday Tuesday Wednesday Thursday Friday Saturday Most Convinant Time Must Check One. Morning 8-11 Lunch 11-1 Afternoon 1-4 Evening 4-8 E-Mail: Add me to your e-mail list.