Request an Appointment

To request an appointment with your Midvale dentist, please complete the information below. A member of our team will then contact you to confirm your appointment. If your need is urgent, please contact our office at 801-676-8100.

    First Name:
    Last Name:
    Email:
    Phone:
    Are you a current Patient?:YesNo

    Office Hours

    	
    
		
			
    
				Tue:
				
				7:00am - 2:00pm
				
			
    
			
    
				Wed:
				
				7:00am - 2:00pm
				
			
    
			
    
				Thu:
				
				2:00pm - 7:00pm
				
			
    
			
    
				Fri:
				
				7:00am - 2:00pm

    Preferred Date:
    Backup Date:
    Backup Date:

    Appointments must be requested at least 2 days in advance.

    Time:

    Comments:

    Additional questions or comments related to your appointment
    1000 character maximum

    Please note that the date and time you requested may not be available. We will contact you to confirm your actual appointment details.

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    Please do not send private or confidential information using this form. Contact our office at 801-676-8100 if you need to provide private information.