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 to confirm your appointment.

Celina Office Hours:
Monday - Thursday 7:30am - 5:30pm
Friday 8:30am - 1:30pm

St. Marys  Office Hours:
Tuesday & Thursday 7:40am - 5:30pm

Rockford Office Hours:
Tuesday - Thursday 9:00am to 5:00pm

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

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.