Appointments

You may request an appointment time via telephone or by filling out the form below and clicking Send. Please check our office hours. Let us know your name, the nature of the appointment and the preferred day of the week and/or time of day and we will do our best to accomodate you. We will email you a confirmation.

INITIAL VISIT FORMS

Appointment Request

First Name

Last Name

Area Code Phone number

Email Address

Reason for Appointment

Preferred Appointment Day Any Day Monday Tuesday Wednesday Thursday Saturday

Preferred Appointment Times Any Time Morning Noon Afternoon Evening

If this is an initial visit or you haven't been seen for awhile, Please print out the following forms, fill them out, and bring them with you. This will expedite your visit.

Patient Registration, Medical History, Dental History

Download the FREE Acrobat reader by clicking here

If you have dental insurance please contact us or bring the forms in before your appointment so that we may determine your insurance benefits before you arrive.

Gordon P Smith, DDS, FAGD
3255 West Maple Rd, Wixom, MI. 48393