COMPASSIONATE PROFESSIONALS IN A COMFORTABLE ENVIRONMENT

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. For new patients, please bring a copy of your insurance card. We are only in network with Delta Dental, all other insurances are considered out of network, please check with your insurance before scheduling if you have any out of network benefits

Please do not use this form to cancel or change an existing appointment.
*Items in bold are required.
Are you a current patient?


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.
Phone: 812-332-1866
Fax: 812-332-5540

312 South Swain, Bloomington, IN 47401