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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 at (925) 634-1230 or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

If you were already sure of what you need and don't have any questions to be answered by us over the phone, click HERE and we can let you schedule your new patient or existing patient re-care hygiene appointments through our partnership with LocalMed online.  We will touch base with you when we are in the office.  Don't forget to fill out your new patient forms electronically and securely so we can make sure to see you promptly at your appointment time.  


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?
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.