New Dental Appointment Request

You may request a new patient dental appointment using the form below, or you may call us at (940) 766-6306. Once you have completed the form below and submitted it to us you will be contacted by phone no later than the next scheduled business day.

This form is for new dental patients only. Established Community Healthcare Center patients must request an appointment by using the patient portal or by calling (940) 766-6306.

New Dental Appointment Request Form

* Indicates a required field.

Name*
Prefix First Middle Last Suffix
Phone*
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Preferred Day of the Week*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Preferred Time of Day*
- Early Morning
- Late Morning
- Early Afternoon
- Late Afternoon
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