Call: (203) 853-4763

Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

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

Business Hours
Mon: 8:00 AM - 6:00 PM
Tue:  8:00 AM - 6:00 PM
Wed: 8:00 AM - 5:00 PM
Thu:  8:00 AM - 5:00 PM
Fri:    8:00 AM - 12:00 PM
Sat:   8:00 AM - 12:00 PM

*Daily Lunch Hour from 1:00 PM - 2:00 PM

*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.