Appointments Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!NamePhone*By providing a telephone number and submitting the form, you consent to be contacted by SMS text message from Complete Dental Care PC. Message frequency may vary. Message and data rates may apply. Please Reply STOP to opt out of further messaging. Reply HELP for more information.Email* Preferred Date* MM slash DD slash YYYY Preferred TimeMorningAfternoonEveningNature of Visit*No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent: this information will not be shared with any third parties.CommentsThis field is for validation purposes and should be left unchanged.