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.  If you are a current patient of ours, please tell us who your regular dentist is.  Thank you. 

Please do not use this form to cancel or change an existing appointment.
*Items in bold are required.
Are you a current patient?

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

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

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


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Office Location

  • Victoria
  • 186 - 3147 Douglas Street
  • Victoria, BC
  • V8Z 6E3
  • Map & Directions
  • Call: (250) 384-1154