Request an Appointment

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Request an Appointment

We work hard to accommodate our patients’ appointment needs, however, we may not be able accept all requests. If you need to see the dentist within the next few days, please call us directly at 615-672-7221 to speak to our patient care coordinator.

Your Name*
First Last
Email*
Phone
Patient's Name
Patient's Date of Birth*
Month
Day
Year
Appointment Type*
- Pediatric Dentistry
- Orthodontics
Date
1st Choice 2nd Choice 3rd Choice
Preferred Time

: Hours

Minutes
Preferred Time

: Hours

Minutes
Preferred Time

: Hours

Minutes
Notes
*If you're booking for multiple patients, please provide additional information here, including their date of birth and name.
*To help expedite the process, you may also provide your dental insurance information.
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Phone
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Request an Appointment

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