Request An Appointment


12 Porter Street Melrose    |     MA 02176

Appointment Request

Make Your Appointment with the Dentist Today!

To request appointment availability, please fill out the form below. Our scheduling coordinator will contact you to confirm your appointment or call 781-665-1552.


Is there a specific date that you would prefer?

Is there a specific time that you would prefer?

What day of the week would you like to come in?

What time of day do you prefer?

Full Name (required)

Email Address (required)

Phone Number (required)

Please describe the nature of your appointment:

Please do not submit any Protected Health Information (PHI).


New patients remember to download and fill out your New Patient Form ahead of time!

Consent Form

Medical History Form


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