Appointment Request

Appointment Requests

Please fill in our appointment request form below, we will contact you shortly to confirm your appointment request.

Practice Hours:

Monday: 10:00 AM - 8:00 PM
Tuesday: 11:00 AM - 6:00 PM
Wednesday: 10:00 AM - 4:00 PM
Thursday: 10:00 AM - 8:00 PM
Friday: 8:00 AM - 4:00 PM
Saturday: 9:00 AM - 3:00 PM (only open certain Saturdays)

Additional Information: Our office is happy to complete and forward all insurance documents pertaining to your dental treatment. Our professional services are rendered to you, therefore you are directly responsible to us for the obligation of payment for treatment. You will be variably reimbursed by your insurance company. We thank all our patients for their consideration in regards to this policy.

Please do not use this form to cancel or change an existing appointment.

*Items in bold are required.

Name: Please enter your name Email: Invalid Email address Phone: Please fill in phone or email address!

Are you a current patient?

Yes

How did you hear about us?

Which office location(s) would you prefer for your appointment?

Guelph 31 Farley Dr

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

Any DayMondayTuesdayWednesdayThursdayFridaySaturday

Preferred time(s) for an appointment?

Any TimeMorningAfternoon

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

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

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Contact Us. We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

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