At this time, we do not accept Medicaid. Please check with the local Medicaid office to locate a participating provider.
Appointment Request for:
Name of Patient:
Reason for Appointment:
Cleaning and X-Ray
Toothache or Other Emergency
Insurance: (leave blank for none)
Enter a date for your requested appointment:
Enter a time for your requested appointment:
Morning or Afternoon?
Please type "123" in the box below to validate your