479.648.9988

Request Appointment Online


Request Appointment  forms can be submitted 24 hours a day.

We review requests from 8:00 AM – 4:30 PM, Monday – Friday. Appointments will be made based on availability. Your appointment is NOT confirmed until you’ve received an email or phone call from one of our office assistants. All information submitted will be treated as highly confidential. If this is an emergency, call our office at 479.648.9988.


Step 1 : Enter your patient & contact information

Patient Name*
Parent or Guardian (if under 18)
Patient's Date of Birth*
   
Phone Number*
Your Email Address*
Mailing Address*
City*
State*
ZIP Code*

Step 2 : Select a desired appointment time

Desired Date
   
Desired Time*
   
Preferred Time to be Contacted*
Are You a New Patient?*
IMPORTANT: If you are a new patient, please download & fill out the new patient form located on the Resources page.

Step 3 : Briefly describe your dental needs

Dental Needs*
How did you hear about us?