Appointment Request

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

If you are a patient of record, please complete the appointment request form below and we'll respond within 48 hours.

Please do not use this form to cancel or change an existing appointment, or if you are a new patient.

If you need to cancel or change an appointment, please call our office at 507-744-2359. If you are a new patient, please click the RESOURCES tab at the top of this page . 


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

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