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

 

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Select preferred day(s) for your appointment:
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY

Select the time of day you prefer:
ANYTIME
MORNING
MIDDAY
AFTERNOON

Step 2: Please provide your contact information.
*Required

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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.

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Bangor Family Dentistry
83 Ridgewood Drive
Bangor, ME 04401
(207) 947-4767

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