accessibility ACCESSIBILITY
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 patient treatment coordinator will contact you to coordinate your appointment.

Changes or cancellations to existing appointments cannot be made using this form. Please call the office at 304.264.9227 where we would be delighted to help you with any scheduling needs.

Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
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.