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.

MetroSouth Hospital Pavilion
2310 York Street Suite 4B
Blue Island, IL 60406

PHONE (708)388-0001


Please do not use this form to cancel or change an existing appointment.


MONDAY   10:00 A.M.-6:30 P.M.
TUESDAY  1:00 P.M. - 6:00 P.M.
WEDNESDAY  8:00 A.M. - 7:00 P.M
THURSDAY  8:00 A.M.-  6:00 P.M.
SATURDAY  8:00 A.M.- 12:30 P.M.

*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.

Healthy Smiles

What does your smile say about you? Let us help you radiate confidence with a healthy smile.