Michael H. Fisher DDS - Request an Appointment

For your convenience, we will try to arrange your office visits for times that fit your schedule. For routine dental services or to set a time for a consultation for reconstructive or cosmetic dentistry, please use this form to request an appointment.

Please complete as much of this form as possible,
then click the "Request an Appointment" button at the bottom of this page.

*Required

*Your Name:

*Your Email Address:

Please note the reason for your appointment request:

Be as specific or as general as you like (i.e. -- "I need a cleaning"
or "I would like to discuss options for improving my smile", etc).

Office Hours

We work a rotating schedule.
Our office is closed Saturday and Sunday.

What time, (or range of time) is convenient for you?

Be as specific or as general as you like (i.e. -- "Monday 12/29/02 at Noon"
or "Any Tuesday or Thursday before 2:30PM", etc).

Are you a new patient? Yes No

Please provide phone number/s where our office can reach you:

*Home Phone:

Work Phone:

Please contact me by email only

Please tell us how you heard about our office:

Please select one:

Name of referring family member or friend:

We check our email each work day and will usually reply
in 24 hours or less.