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Appointment Request

 

Schedule your appointment today...

 

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. Our scheduling coordinator will contact you to confirm your appointment. 

For patients concerned about the cost of a consultation, Dr. Chambers is offering a Free Initial Consultation to discuss treatment options or to get a second opinion (normally $150.00). What a great opportunity to come in and meet Dr. Chambers and his staff and find out what we can do for you.




Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?

Which office location(s) would you prefer for your appointment?
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.):