Request An Appointment

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 to confirm your appointment.
– Please do not use this form to cancel or change an existing appointments.
* Items are required.

Name*
First Last
Phone*
Email*
Are you a current patient?*
- Yes
- No
Address*
Street Address City State / Province / Region ZIP / Postal Code
Preferred day(s) of the week for an appointment?
- Any Day
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

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

Request An Appointment

Request an Appointment

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