Appointment Request

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.

Office Hours are 8:30pm to 4:30pm
By Appointment Only

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


Which office location(s) would you prefer for your appointment?



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.):

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

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Office Locations

  • Eureka
  • 3142 Harrison Ave
  • Eureka, CA
  • 95503
  • Map & Directions
  • Call: (707) 798-6383
  • Arcata
  • 791 Bayside Rd., Suite 1
  • Arcata, CA
  • 95521
  • Map & Directions
  • Call: (707) 798-6383
  • Fortuna
  • 1001 Loni Drive
  • Fortuna, CA
  • 95540
  • Map & Directions
  • Call: (707) 798-6383