Call or request an appointment.

Request an appointment

Send a non-urgent request and the office will contact you to discuss scheduling. Submitting this form does not reserve or confirm an appointment.

For dental pain, swelling, an injury, or a damaged tooth, call (205) 991-8939 instead of using this form.

Full name

Phone number

Email (optional)

What would you like to schedule? Select one New patient visit Exam or cleaning Cosmetic consultation Restorative care consultation Something else

Best time to call (optional)

Scheduling note (optional)

Do not include health information, insurance numbers, payment information, or other sensitive details.

Send Appointment Request

The office will contact you to discuss scheduling. This form does not confirm an appointment.