Appointment Request

Let’s schedule your appointment.

Please note this system cannot modify scheduled appointments. To reschedule an existing appointment, please call our office during regular business hours at (480) 943-1900.

Are you a new patient?

Full name Email

Phone We’ll use this to confirm your appointment.

How would you like us to reach you?

Which tooth is bothering you? If known, enter the tooth number. If unknown, describe where your concern is located.

Symptoms

How did you hear about us?

Do you have dental insurance?

Preferred appointment date Weekdays only (Monday to Friday). We’ll do our best to accommodate your selection. We’ll call you shortly to confirm a date and time.

By submitting, you agree we may contact you about your appointment request. Please do not include sensitive medical details in this form.

Prefer to talk to us? Call (480) 943-1900 during business hours.