Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our Whittier family & cosmetic dental office by phone @ (562) 906-6400 or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment. Please indicate in the message box below whether you prefer to be contacted by phone or email.

In an effort to make your dental visit with us as efficient as possible, you may download and print necessary patient forms prior to your appointment. Fill them out in the comfort of your home and bring them with you to your scheduled appointment along with your drivers license and insurance card. Just click on the link below to access our patient forms.  


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

Items in bold are required.
Are you a current patient?
Best time(s) to call?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

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