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Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to schedule an appointment

The best way to reach us is by calling the office directly. Filling out this form does not guarantee an appointment. This request only prompts our office to contact you to schedule an appointment.

IF YOU NEED AN EMERGENCY APPOINTMENT(within the next 24-48 hours) due to pain, please CALL THE OFFICE DIRECTLY to schedule it, as it is the quickest and easiest way to reach us. 

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

 

DURING THE COVID PANDEMIC, WE ARE OPERATING ON A LIMITED SCHEDULE FOR EMERGENCY PATIENTS ONLY. IF YOU ARE HAVING A DENTAL EMERGENCY, PLEASE CONTACT US AT  407 814-4940

 WE WILL BE HAPPY TO ACCOMMODATE SHOULD YOU HAVE ANY OF THE FOLLOWING EMERGENCY ISSUES:


  • Severe dental pain from tooth pulp inflammation

  • Wisdom tooth pain

  • Surgical postoperative inflammation or dry socket dressing changes

  • Abscess or infection with pain and swelling in the mouth

  • Tooth fracture (crack) with pain or trauma to the soft tissues of the mouth

  • Knocked out or significantly loosened tooth

  • Loss or damage to temporary crowns or other restoration causing pain or gum irritation




*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 not considered private. Please contact our office by telephone if sending highly confidential or private information.