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. Our scheduling coordinator will contact you to confirm your appointment.

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

In case of emergency, please call the office directly. 


Patient Information

Patient Availability

Reason For Visit

If you do not receive a response to your request within 2 business hours,

please call Erin at 515-993-3701.  Thank you.

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