Request an Appointment

If you are having a current dental issue that needs immediate attention, please CALL the main number for our clinic at (708) 422-6655. We will be able to assist more quickly by doing so.

Otherwise, please fill out the form below to request an appointment. A Dental Associates representative will be contacting you to schedule your appointment.

(Dental Associates will not share your information with outside parties.) Appointment requests are monitored and responded to during normal dental center business hours.

* Patient Type:
* First Name:
* Last Name:
* E-mail:
* Phone:
Reason for Appointment Request: