Request an Appointment

The first step toward achieving a beautiful, healthy smile is scheduling an appointment.  To do so, complete and submit the appointment request form below.

Please note this form is for requesting an appointment only.  Should it be necessary to cancel or reschedule an existing appointment, or if there is an urgent concern requiring immediate attention, please contact our practice directly at (910) 436-1922.

    Patient Name *

    Parent Name

    Email *

    Phone *

    Preferred Day *

    Preferred Time *