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Call for an appointment: Burke, Virginia 703.503.8996

WE ARE ACCEPTING NEW PATIENTS
 

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our Lexington dental office by phone @ 336-503-8996 or complete the appointment request form by clicking on "New Patient Form" below. Our scheduling coordinator will contact you to confirm your appointment. 

IF YOU ARE A NEW PATIENT, PLEASE FILL OUT A NEW PATIENT FORM AND BRING IT WITH YOU TO YOUR FIRST APPOINTMENT. 

THANK YOU FOR SELECTING US FOR YOUR DENTAL NEEDS.  WE LOOK FORWARD TO SEEING YOU.   

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:
Email:
Phone:  
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.