Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

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

Patient Information

Patient Availability

Reason For Visit

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

Where to Find Us

Call: (613) 342-5166

309 Park St. Suite 206
Brockville, Ontario K6V 6E5

Email: 123smiledoc@gmail.com

309 Park St. Suite 206|
Brockville, Ontario K6V 6E5

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