Appointment Request

The first step towards a beautiful, healthy smile is to review your orthodontic needs with us. Please contact our office by phone or complete the appointment request form below. Our Treatment Coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.


*Items in bold are required.
Are you a current patient?

Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are considered private. We will not distrubute your email address or message to any outside source.