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!*



Hours Of Operations

Mon - Thurs. 8:00a -12:00p & 1:30p - 5:00p

Fri. 8:00a - 12:00p

Sat. - Sun. Closed



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

1895 Orange Tree Lane     |     Suite 203     |     Redlands, CA 92374     |     Call (909) 307-5353
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