Dentist North Lake Appointment Request

Need an appointment with a dentist? Requesting an appointment at our family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with today!


Types of Payments Accepted

  • Cash
  • Amex
  • Visa
  • Discover
  • Mastercard
  • Most PPO insurances
  • CareCredit
  • Public aid
  • Other payment plans available
Patient Information (* denotes fields that are required)
Patient Name*
Phone Number*
Email Address
Are you a current patient?
No Yes
Best time(s) to call?
Morning Noon Afternoon Evening
Appointment Information
Choose Location:
Preferred Appt Date
Preferred Appt Time
Describe the nature of your appointment or any other comments