The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our Burgess dental office by phone by calling 804-453-4361 or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.
If you are a new patient to our office, the forms below will need to filled out when you arrive for your first appointment in our dental office. Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival. Thank you and please call our dental office if you have any questions or need any assistance.
Patient Registration Form
This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.
Please do not use this form to cancel or change an existing appointment.
Items in bold
Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.