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Request or Confirm an Appointment
 

Request an appointment   Confirm an appointment   Call us Today! 507-288-1188

Requesting an Appointment:

Please fill out the form below to request an appointment with our office. Click the "Submit" button to send the request to one of our appointment coordinators. If you are having a dental emergency, please call us in lieu of using this form. Thank you!

*Name (Last, First)

*E-Mail Address

*Phone Number

*Date of Birth

*What type of appointment are you looking to schedule?
Exam/Cleaning
Other
If Other, please specify

*How long has it been since your last checkup?

*Do you suspect you have any current dental problems?

*Do you have dental insurance?
No
Yes
If Yes, please specify name of insurance company
Have you previously been to our office?
Yes No

Preferred days/times?
(blank if no preference)

Mon a.m.
Tue a.m.
Wed a.m.
Thu a.m.
Fri a.m.
Mon p.m.
Tue p.m.
Wed p.m.
Thu p.m.

Office Hours

Monday–Thursday
7:00 a.m.–5:00 p.m.

Friday
7:00 a.m.–1:00 p.m.

Do you have a preferred dentist?
No Michael F. Lose, DDS
Jacob M. Peters, DDS
Robert R. Stroope, DDS
Kristen A. Templeton, DDS
James P. Watson, DDS

Please use the area to the right to add any information pertinent to your appointment request.

 


Confirming an appointment:

We appreciate you taking the time to confirm your upcoming appointment. We ask if you are unable to keep your appointment or are going to be late, please contact us by phone at least 24 hours in advance to allow your time to be utilized by another patient.

*Name (Last, First)

*E-mail Address

*Phone Number

*Confirming Appointment Date and Time:

Please use the area to the right to add any information pertinent to your upcoming appointment.

Would you like us to contact you regarding this appointment?
No Yes