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Appointment Request

Call 630-836-8880


 


The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.

 

*Items in bold are required.
Are you a current patient?


Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

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Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

 

CONVENIENT CONFIRMATIONS FOR APPOINTMENTS! 

 Smile Reminder is our automated reminder system. This system reminds our patients of their scheduled appointments, pre-medications and upcoming appointments they will need to schedule via: Email, text and automated voice messages. Not only does this conveniently confirm and remind you of appointments, our system also has the ability to create personal accounts for our patients. These accounts allow you to request appointments directly to our office, view upcoming appointments, make payments securely online, update your personal information and send secure messages directly to our office. If you are interested in this helpful tool just call our office and we can assist you in setting up a login name. If you prefer to set up an account or already have an account and would like to access it, please type the web page listed below. 

www.MyReachPortal.com 


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