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Cancellations
Appointment cancellations require 48 hours notice and must be made by phone. Cancellations through this online form will
NOT
be accepted.
First Name:
*
Last Name:
*
Email Address:
*
Phone Number:
*
*
required field
New Patient
Existing Patient
Choose the days of the week that you are available:
(use control-click to select multiple dates)
Monday
Tuesday
Wednesday
Thursday
Friday
Monday to Wednesday:
9am - 6pm
Thursday: 10am - 7pm
Friday: 9am - 2pm
Best time for appointment:
8am-11am
11am-2pm
2pm-5pm
5pm-7pm
Reason for appointment:
regular checkup/cleaning
new patient visit
ongoing treatment
cosmetic procedure
pain
swelling
bleeding
What is the best way to contact you to confirm your appointment?
Please email me
Please call me
Morning
Afternoon
Evening
view past issues
Email: