Facebook Instagram TikTok Yelp YouTube Patient Portal
(919) 577-9009 Appointment Request
Close

Appointment Request

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.

Appointment Request
Name
Name
First
Last
Are you a current patient?

Patient Availability

Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?

Reason For Visit

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