"Dr. Connerly made our son feel very comfortable, even though it was an unfamiliar situation. She was also very thorough. When he left, he said "I love going to the dentist!" - Anonymous

Appointment Request

We are excited to meet you and your child! Please complete the appointment request form below. We will contact you to confirm your child’s appointment. Please do not use this form to cancel or change an existing appointment. Instead please contact our office. Please provide a number where you can be reached during our 9 am to 5 pm business hours.

New Patient Appointment
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Current patient appointment
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Parent/ Legal Guardian Name

Child's Name

Email

Daytime phone number

Address

City, State, Zip

Reason for appointment

Preferred day(s)
Monday  Tuesday  Thursday  Saturday

Questions or Concerns

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