Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Office hours are Monday - Friday 8 am-5 pm. Our scheduling coordinator will contact you to confirm your appointment.

WE ARE CURRENTLY EXPERIENCING TECHNICAL ISSUES WITH OUR PHONE SYSTEM. IF YOU ARE UNABLE TO GET A CONNECTION, PLEASE EMAIL US AT info@familydentistryonthesquare.com WE WILL CONTACT YOU AS SOON AS POSSIBLE.

IF YOU NEED TO CONTACT US AFTER OFFICE HOURS DUE TO A DENTAL EMERGENCY, PLEASE CALL OUR EMERGENCY LINE AT  234-525-8161.

PLEASE BE ASSURED WE ARE WORKING TO CORRECT THE ISSUE! THANK YOU FOR YOUR UNDERSTANTING!



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?

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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.

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Contact Us. We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.