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5901 N. Lidgerwood St. Suite 225, Spokane, WA 509-590-1763 Request Appointment
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Request an Appointment

Please fill out the form below and we will contact you with an appointment time.
All Fields are Required.

Patient Information

First Name: *

Last Name: *

Address: *

City: *

State: *

 

Zip: *

 

 

Birthday: *

  

Email address: *

Phone: *

 

Prefered contact method? *

  Email   Phone  

 

Prefered time to be contacted? *

 

Appointment Type Requested: *

 New Patient
 Cleaning & Exam
 Emergency/Pain/Broken Tooth

Insurance Member ID: *

Prefered Appointment Day: *

Prefered Appointment Time: *

 Morning  Afternoon  Evening  Any  

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HOURS

Mon: 7am – 6pm
Tues: 7am – 6pm
Wed: 7am – 7pm
Thur: 7am – 6pm
Fri: 7am – 5pm
Sat: 8am – 4pm



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