Appointment Request

The first step towards a beautiful healthy smile is to schedule an appointment.  Please contact our office by telephone at 412-687-3232 or complete the appointment request form below.  Our staff will contact you to schedule your appointment.

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

Full Name:

Address:

City:   State:   Zip:

Email:

Phone: Best time to call: Morning   Midday   Afternoon

Preferred day(s) of the week for an appointment?   Any day
Monday   Tuesday   Wednesday   Thursday   Friday

Preferred Time(s) for an appointment? Any Time
Morning   Mid-day   Afternoon

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.

We monitor our incoming online communications several times a day and will usually reply within one business day during open hours.