Request an Appointment

Please fill out the form below and we will contact you with an appointment time. Required fields are marked with asterisks (*).

Patient Information

Name: *

Phone: *

Email address: *

Have you visited our office before? *

Yes No  

What is the reason for the appointment? *

  Regular Exam / Cleaning
  Specific Concern / Procedure

What concerns, if any, would you like to speak to the doctor about:

How do you prefer to be contacted? *

  Email   Phone  

For which location are you requesting an appointment? *

 

Submission

 
 

It may take a moment to submit your information. Please wait for a confirmation message.

 

Winston-Salem:

3801 Indiana Ave, Winston-Salem, NC 27105

Phone: 336-331-5271

Hours:

Mon - Thur: 8am - 5pm
Fri: 8am - 1pm

Greensboro:

1037 Homeland Ave, Greensboro, NC 27405

Phone: 336-272-0132

Hours:

Mon - Thur: 9am - 5pm
Fri: 9am - 1pm





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