Appointment Request Want to schedule a visit? Just fill out the following form below and we will get in touch. Name* First Last Email* PhonePreferred appointment date* Preferred appointment time* : HH MM AM PM Alternate appointment date Alternate appointment time : HH MM AM PM Nature of appointment (eg. toothache, cleaning)Message/CommentsRemember: This is a only a request for an appointment. We will call you back to confirm your date and time. This iframe contains the logic required to handle Ajax powered Gravity Forms.