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.

Office Hours:
Monday 8:00am - 12:00pm, 1:00pm - 5:00pm
Tuesday by appointment
Wednesday 8:00am - 12:00pm, 1:00pm - 5:00pm
Thursday by appointment
Friday by appointment

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

*Items in bold are required.

Name: Email: Phone:

Are you a current patient?

Yes

Preferred day(s) of the week for an appointment?

Any DayMondayWednesday

Preferred time(s) for an appointment?

Any TimeMorningAfternoon

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.

Office Location

Carroll
2008 N. US Hwy 71

Carroll, Iowa

51401

Map & Directions

Call: (712) 792-6455