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
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    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.