Appointment Request

The first step toward achieving a beautiful, healthy smile is to schedule an appointment. To schedule an appointment, please complete and submit the request form below. Our scheduling coordinator will contact you soon to confirm your appointment.

Please note this form is for requesting an appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly.

New Text Messaging Option!

No time for a phone call? You can now TEXT us regarding:

• New Patient Exams
• Current Patient Appointment Times
• Questions & Comments

Just send us a message at 832-588-0144 during our regular business hours.
Please note this line is only for text messages.

Patient Name *

Parent Name


Phone *

Type of Appointment

Preferred Location *

Preferred Date *

Preferred Time *