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

This form can't be used to change or cancel an appointment. Please call (323) 264-8834.
*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: We care about your privacy. If you're sending extremely confidential or private information, please contact us by phone instead (323) 264-8834.

Dental Health

Let our dedicated dental professionals help you achieve a smile that you can be proud of!



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