Appointment Request Form

To request an appointment with our office, please complete the following information and then click Submit.

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

At Dr. Hanfland’s office we work with you so that financial commitments do not prevent you from benefiting from the quality of care you desire and need. Click here to learn more about our financial arrangements.

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

    Is there a specific date that you would prefer?

    What day of the week would you like to come in?

    What approximate time do you prefer?

    Which is more flexible for you?

    What type of appointment do you need?

    Are you a new or existing patient:

    NEWExisting Patient

    Full Name (required):

    Your Email (required)

    What is the best time to call?

    What is the best number to contact you?

    Please describe the nature of your appointment request: