Online Appointment Scheduling Form

Complete this form to request a new appointment with our dentist. Please do not use this form to re-schedule existing appointments. To arrange a different day or time for an existing appointment, call our office: (207) 947-4767



Select preferred day(s) for your appointment:

Select the time of day you prefer:

Step 2: Please provide your contact information.



Appointment requests are answered promptly; usually in less than 24 hours. Sending this form is simply a request for a dental appointment. You are under no financial obligation. Our office observes HIPAA Federal regulations that protect your privacy. We will never release any information about you without your written consent.

Sugarless Gum
Tooth Whitening
Bangor Family Dentistry
83 Ridgewood Drive
Bangor, ME 04401

(207) 947-4767

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