Appointment Request

Like short waits? Dr. Shore has one of the shortest waiting room times in the area. Your time is important so we don't waste it.


If you would like to schedule a cleaning or treatment, please fill-out and submit the form below. We will reply shortly.

If you prefer to speak with us on the phone to discuss your situation or schedule an appointment, please call 916-966-4341 (Mon-Fri, 8:30am-5:00pm).

 





* = Required Field

*Full Name:

*Telephone Number:

Email Address:

*Appointment is For:

New or returning patient?
 New Returning

Patient’s Name (only if different than above):

*Reason Requesting Appointment (check any that apply):
 Exam/Cleaning Unexplained Pain/Toothache Periodontal Concerns/Gum Disease Teeth Whitening Veneers/Smile Makeover Implants Dentures Other

Is this an urgent concern?
 Yes No

*How did you hear about Dr. Shore?:

Details/Comments:

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