Online Appointment Form

Complete this form to request a new appointment with our dentist. Please do not use this form to re-schedule existing appointments. To arrange a different day or time for an existing appointment, call our office: 207-947-4767

Step 1: Briefly explain your dental needs.

Select preferred day(s) for your appointment:
Monday Tuesday Wednesday Thursday Friday

Select the time of day you prefer:
Anytime Morning Midday Afternoon

Step 2: Please provide your contact information. (* = required)

*Your Name:

*Phone Number:

*Email Address:

Best Time to Call:

Step 3: From where or by whom were you referred?

Type the two words displayed, separated by a space, then click
the "Send Appointment Request" button.

Appointment requests are answered promptly; usually in less than 24 hours. Sending this form is simply a request for a dental appointment. You are under no financial obligation. Our office observes HIPAA Federal regulations that protect your privacy. We will never release any information about you without your written consent.