Appointment Request

Request an appointment and we'll take it from there.

Fill this out and our staff will review it. Submitting the form does not confirm or reserve an appointment — we'll contact you to set a time.

Having urgent dental pain?

Please call (510) 532-8972 instead. Online requests are not monitored continuously, so we may not see this form right away.

Patient information

First name*

Last name*

Date of birth*

Used with your name and member ID to check eligibility.

Preferred language*

Mobile phone*

Email address*

Preferred contact method*

Phone callText messageEmail

How should we reach you about this request?

Step 1 of 4

Prefer to do this over the phone? Call (510) 532-8972 — Monday to Friday, 9am to 5pm. Walk-ins are welcome during office hours.