Make An Appointment

To make an appointment, simply call us at (270) 527-1479 during business hours:

Monday thru Friday 7:00 a.m. to 6:00 p.m.

Saturday 7:00 a.m. to 1:00 p.m.

or fill out the information below and we will contact you shortly to set up a time that's convenient for you!

NOTICE: The following form is not secured by encryption. If you are concerned about sending information through an unsecure channel, please call our office.

*Required fields
	Name: *
	Daytime Phone: *
	E-mail Address: *
	Will this be your first visit with us?
	Yes No
	Nature of the appointment:
	New Patient Exam Cleaning (Regular Checkup) Sedation ("Sleep") Dentistry Consult Cosmetic Dentistry Consult Orthodontics ("Braces") Evaluation Other - Explain:
	Any other comments or concerns:

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