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Appointment Request

Central Scheduling 

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.  Orthodontic care is provided on Tuesdays & Wednesdays at our Millersport location and Monday & Thursdays at our Jackson location.  Please choose accordingly.

To schedule a Sleep Dentistry appointment or a FREE initial consultation concerning your snoring or Sleep Apnea, please note that we are currently only scheduling on Fridays at our Millersport location.  Please choose accordingly.

Our scheduling 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.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?

Which office location(s) would you prefer for your appointment?
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.