AppointmentsPlease use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!NamePhone*Email* Are you a new patient to us?*NoYesPreferred Date* Preferred timeMorningAfternoonEvening (Monday only)Nature of VisitInsurance Carrier*AmeritasAetna (PPO only)Cigna (PPO only)Delta Dental PPO/PremierGuardianHealth Partners (commercial or private)HumanaLincoln FinancialMeritainHealthMetLifePremier DentalThe StandardUnited ConcordiaUnited HealthCarePlease select your dental insurance carrier from the options above: (Please note, we do not accept state insurance at this time)Insurance Member ID/Subscriber ID:*Please input your subscriber ID.PhoneThis field is for validation purposes and should be left unchanged.