Appointment Request

The first step towards your beautiful, healthy smile is to schedule an appointment! Feel free to contact our office via phone or complete the appointment request form below.

Our scheduling coordinator will then contact you to confirm your appointment. Please do not use this form to cancel or change an existing appointment.

Patient Information

Patient Availability

Reason For Visit

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

Professional Associations

American Dental Association Logo American Association of Orthodontists logo Roth Williams International Society of Orthodontists logo California Dental Association logo The Pacific Coast Society of Orthodontists logo Santa Clara County Dental Society logo