New Appointment Requests

You can use this form to request a new dental appointment. If this is your first visit, consider filling in a new patient form before you see us. Please do not use this form to re-schedule an existing appointment -- instead call our office: 860-666-7910.
Weekly Office Hours
Monday Tuesday Wednesday Thursday Friday
8 AM - 6 PM 8:30 AM - 6:30 PM 8 AM - 6 PM 8 AM - 6 PM 8 AM - 5 PM
Are you one of our patients?
Yes, I am a current patient    No, I am a new patient
Briefly explain your needs: (e.g., consultation, check-up, etc.)
Select preferred day(s) of the week for appointment:
Monday   Tuesday   Wednesday   Thursday   Friday
Select the time of day you prefer for your appointment:
Any time   Morning   Noon   Afternoon
Please provide your contact information:   *required fields
*Your name:
*Phone number:
*Email address:
Best time to call you:
How did you find us?
Send your request:  
Appointment requests are answered promptly; usually in less than 24 hours. Sending this form is simply a request. You are under no financial obligation.