ACCESSIBILITY
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.

Please do not use this form to cancel or change an existing appointment.  At Pine Grove Dental Arts our appointment times are reserved so we can dedicate our time to treat each patients' individual needs.  We value advance notice from our patients who are unable to honor their reservation with our doctors and hygienists.

To deter short notice cancellations, we require any appointment that is no longer needed or is unable to be kept, must be changed at least 48 hours prior to the appointment.  We must honor all of our patients’ time.  Those patients who do not arrive at their reserved appointed time will be considered on a case by case basis and may be rescheduled for another date.  Individuals who fail to comply with our 48 hour notification policy may incur a charge to their account.


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.