Request Your Appointment

First Name

Last Name

Phone Number

Requested Appointment Date

Requested Time (select all that apply)

Early Morning (9 -11 am) Late Morning (11 am -1 pm) Early Afternoon (2 - 3:30 pm) Late Afternoon (3:30 - 5 pm)

Select Location

Pompano Beach Office Lauderhill Office

Any Special Comment?

Please, be advised that this form is not to be used for medical purposes. By no means should you try to contact your doctor or health care provider using this form.
We are HIPPA compliant and will not share your information with anyone.

We will contact you to confirm the exact date/time of your appointment.

Disclaimer: All the material presented in this website is to inform and educate patients. However, every case or individual is unique and therefore, it should not be used to take any diagnostic or therapeutic decision without previously consulting a licensed dentist.

ADA Compliance: The publisher of this website is committed to providing an accessible website. If you have difficulty accessing content, have difficulty viewing a file on the website, or notice any accessibility problems, please contact us to specify the nature of the accessibility issue and any assistive technology you use. We strive to provide the content you need in the format you require.