Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment.

Please contact our office by phone at (909) 558-4960 or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.
Please do not use this form to cancel or change an existing appointment.

WE ACCEPT RISK MANAGEMENT & ARE PREFERRED PROVIDERS FOR CIGNA PPO (RADIUS PLAN) - and will courtesy bill all PPO insurance plans. (NOTE: Our providers are NOT contracted with Denti-Cal, MediCal, or Delta Dental)

Our office accepts CareCredit and you can pay your doctor directly by clicking here:  CareCredit "Pay My Provider"

*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.

Hours of Operation:

Monday, Tuesday, Wednesday, Thursday: 8:00 am to 5:00 pm

Friday:  8:00 am to 12:00 pm