Appointment Request

Call (562) 941-3216

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. 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.
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.

*We request at least a 48 hour prior notice if you cannot keep an appointment, and we reserve the right to charge a $50 missed HYGIENE appointment fee, and a $100 missed DOCTOR appointment fee.*

Dental Health

As dental professionals it is our priority to provide quality dental care you can trust.

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