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Appointment Request

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 within 1-2 business days to confirm your appointment.

Please do not use this form for emergencies or to cancel/change an existing appointment.

Our Office is located at 30 Minto Road, Palmerston, Ont.


Patient Information

Patient Availability

Reason For Visit

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.