Appointment Request

We welcome all patients to request an appointment using the form below.
We will be in touch to confirm a time that fits with your schedule.

We want to help!

A Smile Gallery is open Monday, Wednesday and Thursday from 9 am until 6 pm, Friday from 9 am until 1 pm and every other Saturday from 9 am until 1 pm. We make every effort to schedule appointments as promptly as possible.
*For rescheduling or cancellations, please call our office.

If you are human, leave this field blank.

Name *

Email *

Phone

Are you a current patient? *

Yes

Best time (s) to call? *

Morning

Noon

Evening

Preferred day (s) of the week for your appointment *

Any day

Monday

Wednesday

Thursday

Friday

Saturday

Please describe the nature of your visit (Check up, Cleaning, etc.) *

Questions? Contact Us!

We welcome you to call or come in for more information, or for any concerns or questions you may have. We’re happy to meet you and answer.

Click or Call – (909) 875-2095

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