The first step towards a beautiful, healthy smile is to schedule an appointment in the form provided 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

Patient Appointment Request Form

Phone
Are you a current patient?(Required)
Are you a current patient?
Address(Required)
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.):
By submitting this form, I consent to receive SMS text messages from Exceptional Dental for appointment reminders, marketing messages, and general two-way communication. Msg frequency varies. Msg&data rates may apply. Reply HELP for support. Reply STOP to opt out.

Consumer information is not shared with third-parties for marketing purposes. Please view our privacy policy for additional information on why and how customer information is collected.
This field is for validation purposes and should be left unchanged.