Call for an appointment: Glendale, AZ 602. 993. 4200
 

The first step towards a beautiful, healthy smile is to schedule an appointment. Please complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment. 

Bookmark and Share


*Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Email:
Phone:  
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.):

Existing appointments cannot be changed with this form. Please call 602-993-4200 during office hours for any appointment changes. We will be happy to find an appointment time to fit your schedule. 

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

Existing patients can use the Smile Reminder Secure Message portal for sending highly confidental or private information. This portal can be found on the "View My Account Online" button in your emailed appointment reminder. Changes to any other information can be sent to us securely through our Patient Forms page. There you can logon to your private and secure account to update changes to your contact information or dental benefit plan.

Share