ADA Accessibility Information
Accessibility

A
A

A

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:

Confirmation

How do you prefer to be contacted? *

  Email   Phone  

 
 

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

 

Office hours

Mon–Thurs 8:00 a.m.–5:00 p.m.
Fri 7:00 a.m.–2:00 p.m.

Location

3933 N Maize Road
Wichita, KS 67101-9619

¡Hola!

Habla Español

Contact

Office (316) 202-9629
Fax (316) 202-0141