Appointment Request

Request a Dental Appointment Here with Brush Dental

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 appointment.

Business Hours
Monday:         8:00 AM – 4:00 PM
Tuesday:         7:30 AM – 5:00 PM
Wednesday:  7:30 AM – 5:00 PM
Thursday:      7:00 AM – 4:00 PM

Appointment Request
    Name
    Phone Number
    Email
    Are you a current patient? YesNo
    Preferred day(s) of the week for an appointment? Any DayMondayTuesdayWednesdayThursday
    Preferred time(s) for an appointment? Any TimeMorningAfternoon
    Please describe the nature of your appointment (consultation, check-up, etc.):