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(320) 963-3794

Hours

Mon-Thu: 8am-5pm

Request an Appointment

REQUEST A DENTIST APPOINTMENT

Just fill out the form below and an agent will confirm your appointment.

Enter your name *

Patient Status: *

New Patient

Current Patient

Date of Birth: *

Address: *

Enter your email address *

Phone Number *

Reason for Appointment: *

(Select One) Dental Checkup Emergency Appointment Other

Date of last dental visit:

Primary Concerns: *

Preferred weekday(s) for your appointment: *

Monday

Tuesday

Wednesday

Thursday

As soon as possible

Preferred Time: *

No preference 8am-10am 10am-Noon Noon-2pm 2pm-4pm

Dental Insurance?: *

Yes

No

*We do not bill Medical Assistance

Submit

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