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.

PLEASE NOTE: Our office will be closed on Thurs 20th Sept, 2018. We will respond to all messages left when we return to the office on Mon 24th Sept, 2018.

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

*Items in bold are required.

Name: Email: Phone:

Are you a current patient? Yes
No

How did you hear about us?

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

Burnaby 4603 Kingsway

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

Any DayMondayTuesdayWednesdayThursday

Preferred time(s) for an appointment?

Any TimeMorningNoonAfternoon

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

SpamBlocker

Do not fill this textbox.

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

Site Developed by ProSites.com