Appointment Request – 11 Rebecca Street, Suite 100, Hamilton, ON

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone (905-521-2181) or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

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


Are you a current patient?

 Yes No

Best time(s) to call?

 Morning Noon Afternoon Evening

Preferred day(s) for an appointment?

 Any Day Monday Tuesday Wednesday Thursday Friday

Preferred time(s) for an appointment?

 Anytime Morning Afternoon

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.