Call (410) 569-2243

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. One of our staff members will reach out to you within 24hours to schedule a convenient appointment.

Office Hours:
Monday - Friday 8:30am - 4:30pm

Please note that this form cannot be used to cancel or change an existing appointment. 

You must call the office directly.  Thank you!
*Items in bold are required.
Are you a current patient?


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.

Office Location

  • Bel Air
  • 2014 South Tollgate Road Suite 108
  • Bel Air, MD
  • 21015
  • Map & Directions
  • Call: (410) 569-2243
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