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Request Appointment

Request Appointment

Fill out the form below to request your appointment.

Are you a new or existing patient?(Required)

New

Existing

Name(Required)

First Last

Phone(Required)

Email(Required)

What brings you in?

Cleaning or general dentistry

Missing/broken tooth

Wisdom teeth removal

Full arch

Dental implants

Dentures

Other

Preferred day of the week

Preferred time

Morning

Afternoon

Anytime

Preferred contact method(Required)

Phone

Email

Who is your insurance provider?

What type of appointment would you like?(Required)

Cleaning

Emergency

Other

What would you like to do?(Required)

Schedule an appointment

Request a callback

Other

Best time for a callback?

Hours

:

Minutes

AM/PM

Preferred day of the week

Preferred time

Morning

Afternoon

Anytime

Do you have an update to your insurance?

Yes

No

Do you need to update your contact information?

Yes

No

Additional comments

Have a question or want to share additional information? Add them in the box below.

Paperwork(Required)

Before we can schedule your first appointment, we just need a few more details. Click here to fill out your online paperwork—once that’s complete, check the box below.

I have submitted my paperwork online.

725 S 51st St, West Des Moines, IA 50265

Patient Resources

I’m a new patient

I’m an existing patient

Dentists who put your comfort, confidence, and whole health first.

Request Appointment

725 S 51st St, West Des Moines, IA 50265
Monday–Thursday, 8AM–5PM

About
Services
Our Lab
Resources
Request Appointment