Appointment Request

(613) 234-6405

Please complete the form below to request an appointment and we will contact you within 72 hrs to confirm. If your need is of an urgent matter, please call us at 613-234-6405 to speak with Pam or Courtney - they will be happy to help you.
Thank you, and we look forward to seeing you!

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.

Healthy Smiles

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