(336) 227-2733

Appointment Request

The first step toward achieving a beautiful, healthy smile is to schedule a new patient appointment. To schedule an initial appointment, please complete and submit the request form below. Our scheduling coordinator will contact you soon to confirm your appointment. 
Please note this form is for requesting a new patient appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly (336-227-2733). 

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Please provide the patient's name


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