Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone (603) 434-4962 or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

When booking your appointment we do require a deposit from you which is your confirmation of your commitment to attend your appointment. It will be deducted from your bill for the treatment rendered. The reason why we adopted this policy is because the Dr’s time has been allocated and is often very difficult to fill the cancelled appointment time within 48 hours notice. Your appointment is a set time period reserved especially for you. This policy also allows us to operate more efficiently and helps us keep costs low for our patients.

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


Items in bold are required.
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.