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Appointment Request

San Jose Location
4180 N. First St. Suite 80
San Jose , CA 95134
Phone: (408) 435-8000
Fax: (408) 324-1969

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.

You are scheduling an appointment for our 4180 N. First St. Ste. 80; San Jose, CA location.

For our Santa Clara site, please click here

Please do not use this form to cancel or change an existing appointment.
*Items in bold are required.
Are you a current patient?

Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

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.