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.

Office Hours:

Tuesday: 10 AM – 3 PM

Thursday: 10 AM – 3 PM

Friday: 10 AM - 3 PM

Patient Information

Name

Email

Phone

(###)

###

####

Are you a current patient?

Yes

No

Patient Availability

Preferred day(s) of the week for an appointment?

Anyday

Tuesday

Thursday

Friday

Preferred time(s) for an appointment?

Anytime

Morning

Afternoon

Reason For Visit

Please describe the nature of your appointment?

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

Dr. Jordan is so kind, patient, and knowledgeable. Her energy just makes you feel comfortable and she always seems to be smiling and full of happiness whenever I see her. She is extremely skilled and talented and I will not go anywhere else. Patient for life!

Fatima
Dr. Jordan was exceptionally professional, I have a deep fear of dentists and she immediately put me at ease. You can tell she cares for her patients.

Lillian

Appointment Request

Patient Information

Dr. Jordan is so kind, patient, and knowledgeable. Her energy just makes you feel comfortable and she always seems to be smiling and full of happiness whenever I see her. She is extremely skilled and talented and I will not go anywhere else. Patient for life!

Dr. Jordan was exceptionally professional, I have a deep fear of dentists and she immediately put me at ease. You can tell she cares for her patients.

Ready for your first appointment?