Call us NOW! 205.752.1929
6525 Old Greensboro Rd
Tuscaloosa
Pay Now
Home
About
Our Office
Meet The Doctor
Our Team
Review Us!
Our Services
Prevention
Overview
Professional Hygiene Appointments
Children’s Dentistry
Dental Sealants
Digital X-rays
Periodontal Disease
Periodontal Therapy
Periodontal Disease
Causes of Periodontal Disease
Types of Periodontal Disease
Diagnosing Periodontal Disease
Periodontal Disease & Your Health
Cosmetic Dentistry
Overview
Dental Crowns
Dental Bridges
Dental Veneers
Teeth Whitening
Tooth Colored Fillings
Cosmetic Bonding
General Dentistry
Overview
Dental Fillings
Root Canal Therapy
Dentures And Partials
Temporomandibular Joint Disorders
Mouthguards
Sportsguards
Dental Implants
Dental Implants Overview
The Process
The Benefits
3D Treatment Planning
Dental Implants FAQ
Dental Implants
Patient Information
Overview
New Patients
Membership Plans
General Oral Health Topics
Tooth Care
Dental Problems
Pain Management
Dental Tools
Insurance and Finance
Gallery
Blog
Contact
Close
Appointment Request
Please complete the form below and we will contact you about your appointment.
Contact Details
First Name
What is your full name?
Last Name
Select date
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
2. When is your birthday?
Email
*
3. Where can we contact you?
Phone
*
Appointment Details
Reason
*
Cleaning and examination
Emergency (toothache)
Cosmetic procedure
Second opinion
Other (explain below)
1. What is the purpose of this appointment?
Additional Details
2. Please tell us any additional special date / time requirements. If you would like us to make an appointment for other family members, please list the names here.
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.
Δ
This iframe contains the logic required to handle AJAX powered Gravity Forms.
Contact Us
