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Appointment Request

The first step towards an "UNFORGETTABLE SMILE" is to schedule an appointment. Please contact our office by phone @ 540-667-9180 or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Office Hours
Monday 8:00 - 5:00
Tuesday 8:00 - 5:00
Wednesday 8:00 - 5:00
Thursday 8:00 - 5:00
2nd Friday of Month 8:00 - 1:00

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


*Items in bold are required.
Are you a current patient?


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.):

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