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Appointment Request

 
(612) 926-9000

Patient Forms

If you are a new patient to our office, please click this link which contains our new patient packet with forms that will need to be filled out when you arrive at our office. Thank you and please call our office if you have any questions. 

If you are an existing patient, please click this link to update your medical history before your next cleaning appointment.

To release your records and x-rays from your previous office, they may require you to fill out their preferred form.  If you would like, you can try filling out our form online here and we can request on your behalf. It may be best to contact your previous office directly, however. 

It would be our pleasure to serve you! Please contact our dental office either by phone or by completing the appointment request form below. Our scheduling coordinator will be in contact with you shortly to confirm your appointment. 


Please do not use this form to cancel or change an existing appointment. We kindly request that you call us by phone to make schedule changes.

*Items in bold are required.
Are you a current patient?


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.

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