Appointment Request

Make an Appointment With Us

Need an appointment with a dentist in New Hamburg, Wellesley, Drayton or Breslau? Requesting an appointment at any of our dental offices is easy! Just fill out the form below and we'll contact you to find a time that fits your schedule.
Patient Information (* denotes fields that are required)
Patient Name*
Phone Number*
Email Address
Are you a current patient?
No Yes
Best time(s) to call?
Morning Noon Afternoon Evening
Appointment Information
Preferred Appt Date
Preferred Appt Time
Describe the nature of your appointment or any other comments