Name*PhoneEmail* Preferred Date MM slash DD slash YYYY Preferred TimeMorningAfternoonEveningMessage*Privacy and Consent By providing my phone number, I consent to receive SMS text messages from Lewelling Dental Care for appointment reminders, marketing messages and general two-way communication. Message frequency varies. Message & data rates may apply. When you receive a text message, you can reply HELP for support or reply STOP to opt out. Refer to our Privacy Policy and our Terms and Conditions for more information. Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!CommentsThis field is for validation purposes and should be left unchanged.
