Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment at our dental practice in Roseville. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

After scheduling an appointment, please print and fill out the following forms and bring them with you to the appointment: Acknowledgement of Receipt, Practice Guidelines, New Patient Forms & Medical History (to open these files you will need Adobe® Reader®.)

You can also use CareCredit: Healthcare & Medical Financing Credit Card system to schedule an appointment.

Hours of operation:
Monday: 8:00 am – 5:00 pm
Tuesday: 9:00 am – 7:00 pm
Wednesday: 8:00 am – 5:00 pm
Thursday: 9:00 am – 7:00 pm
Friday: 8:00 am – 5:00 pm
Saturday 8:00 am - 3:00 pm

Insurance plans we accept: Aetna Dental, Ameritas, Anthem, Assurant, Blue Shield of CA, Cigna, Delta Dental, Delta Health Systems, First Dental Health, GEHA, Guardian, Humana, MetLife, Northeast Delta Dental, Premier Access, Principal, United Concordia.

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


Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
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.

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