Appointment Request


We are closed Saturday, Oct 19 to Thursday, Oct Oct 24, 2019

If this is a dental emergency, please call Southern Maryland Oral and Maxillofacial Surgery at 410-257-5333 or visit your nearest emergency room. For general questions that do not need a timely response, you can email us at



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 forms below online and submit. 

Patient Forms

*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.


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



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