To set up an appointment, please call our office at 919-969-9330. Or, you can fill out the following form
to request a specific appointment time, and we will contact you regarding openings that fit your schedule.

Last Name: First Name:
Address: City:
State and Zip:   Email:
Phone:
New Patient?: yes   no AM or PM?: am  pm
Preferred Date:   Preferred Time:
Appt. Reason: cleaning and x-rays
toothache or other emergency
cosmetic dentistry
other:
Comments: