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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. Cancellation Policy now in effect: Cancellations or changes must be made at least 24 hours prior to your appointment time. If you need to cancel your appointment due to an emergency please call the office. Late cancellations or missed appointments may be subject to a $50 cancellation fee.

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.