For your convenience, you can request an appointment by filling out the form below. Once you have completed the form, click "Send to Dr. Johns" and you will be contacted by one of our team members. We look forward to seeing your smile!

Name:
Are you a patient of record?:	Yes No
Reason for appointment:	Custom Smile Design Whitening Restorative Appointment Hygiene Appointment Other
Preferred method contact:	Home Phone Work Phone Cell Phone Other
Number:
E-mail address:
What is the best day of the week for your appointment?:	Monday Tuesday Wednesday Thursday
What is the best time of day for your appointment?:	AM PM
Please add your message of any length:	Please give us a call should you have any questions at ( ) Click "Send to Dr. Johns" when you have filled out the above form and you will be contacted shortly.