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Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone 312-332-4424 or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Should you have a dental emergency, please call 312-332-4424 and choose option 4 and follow the prompt to reach a dentist.

Please do not use this form to cancel or change an existing appointment, this form does not guarantee appointment time.

*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.