We want scheduling an appointment at Dental Health Associates of Madison to be easy and fast. Whether you are a new patient or a returning one, try our online form below.

Complete the form below to request your appointment, ensuring all fields are filled out. Be sure to keep in mind that all appointments can take a different amount of time, so sometimes your requested dates may not be available to you. If you do not see your type of appointment below, or have questions about what to choose, please call our office.

We will contact you to confirm your final appointment date and time.

Please do not use this form for emergencies or to cancel or change an existing appointment. Please call the office to do this.

 

Appointment Request Form

ALL fields are REQUIRED unless marked optional

Select a location:

Dentist(s)

Are you a new patient?

Yes

No

Patient Information

Phone numbers must include area code, numbers only and no spaces

Appointment Request Details

Reason for visit:

Optional

Preferred Day(s):

Check all that apply

Any day
Monday
Tuesday
Wednesday
Thursday
Friday

Preferred Time(s):

Check all that apply

Any Time
Early Morning
Mid Morning
Afternoon
Mid Afternoon

For security purposes, please match the slider below to send the form.

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