Appointment Request

The first step toward achieving a beautiful, healthy smile is to schedule an appointment with one of our orthodontists or dentists. To schedule an appointment, please complete and submit the request form below. Our scheduling coordinator will contact you soon to confirm your appointment.

Please note this form is for requesting an appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly.

Contact Information:

Bold fields are required.

 

Do you have Missing Teeth or Loose Dentures?

Fill out our form or call today and schedule your FREE Dental Implant Consultation!

Call: (475) 282-4551

Request Your Appointment Today!
map
12 Month Smiles
Fairfield
(475) 282-4551
Office Hours
  • Tuesday: 9am-6pm
  • Friday: 8am-5pm
  • Saturday: 8am-2pm
  • Sunday: 9am-5pm
map
12 Month Smiles
East Haven
(203) 469-5644
Office Hours
  • Monday-Friday: 9am-6pm
  • Saturday: 8am-2pm