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.

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

Patient Information

NamePlease enter your name

EmailInvalid Email address

PhonePlease fill in phone or email address!

Are you a current patient?YesNo

How did you hear about us?

Patient Availability

Preferred day(s) of the week for an appointment? Any DayMondayTuesdayWednesdayThursday

Preferred time(s) for an appointment? Any TimeMorningAfternoon

Reason For Visit

Please describe the nature of your appointment?

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

Our Practice Hours:

Monday: 9:00 AM - 5:00 PM

Tuesday: 9:00 AM - 5:00 PM

Wednesday: 10:00 PM - 6:00 PM

Thursday: 9:00 AM - 5:00 PM

Countryside Dentistry

Live, Love, Smile

2024

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Our Office

1034 N Hwy 69❘Frontenac, Kansas 66763❘Get Directions❘(620) 232-2273

2024

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