Appointment Request

Request an Appointment

Fill out the form below and our team will contact you to confirm your appointment.

Personal Information

First Name *

Last Name *

Phone Number *

Email Address

Patient Status

Are you a new or existing patient? *

New Patient Existing Patient

Appointment Details

Reason for Visit *

Preferred Dentist or Hygienist

Preferred Date *

Preferred Time *

Insurance Information

Insurance Provider

Policy Holder's Name

Policy Holder's Date of Birth

Member ID

Insurance Company Phone

Additional Notes or Questions

This form is a request only and does not guarantee an appointment. Our office will contact you to confirm your appointment date and time. If you are experiencing a dental emergency, please call our office directly.

Questions about dental services in Gainesville, VA? We encourage you to contact us whenever you have an interest or concern about any of our procedures - from porcelain veneers and dental implants to teeth whitening and dental Botox. We look forward to hearing from you.

Call or Visit Us

(703) 754-5800

Monday through Friday. Same-day consultations available for urgent dental concerns.

Address

7100 Heritage Village Plaza, Suite 101
Gainesville, VA 20155

Office Hours

Mon - Thu: 8:00 AM - 5:00 PM
Friday: 8:00 AM - 2:00 PM
Saturday - Sunday: Closed

Insurance Accepted

New Patients

We are currently accepting new patients from Gainesville, Haymarket, Bristow, Manassas, Warrenton, and surrounding Northern Virginia. New patient information and forms here.

Request an Appointment Online

Our Location

Find us on the map

Hours of Operation

Our Regular Schedule

Monday:

8:00 am-5:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

8:00 am-5:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

8:00 am-2:00 pm

Saturday:

Closed

Sunday:

Closed