Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment.

Please contact our office by phone at 573-756-6415 or complete the appointment request form below. Our scheduling coordinator will contact you to then setup the appointment. 

Sending a request is not confirmation of appointment.
Please do not use this form to cancel or change an existing appointment.

*Items in bold are required.
Are you a current patient?


Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.