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Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone (410)257-2424, or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment during regular business hours. We will do our very best to accommodate your request. 

We now have an easy way for you to fill out paperwork before your appointment.  Please fill out the form below then fax (410)257-2299, e-mail (office@dunkirkdental.com), mail or simply bring with you to your appointment.

 

 New Patient Paperwork:

Patient Registration and Medical History

Privacy Information

Privacy Information Acknowledgement

Financial Policy

Laser Bacterial Reduction 

Records Release

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

*Items in bold are required.


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.):

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

 

We are looking forward to assisting you during regular business hours.

 

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