Ellicottville Dental Group
Creating Beautiful Smiles

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.

Your appointment time is reserved just for you. If you’re unable to keep your appointment please give us at least 24-hours notice to avoid being charged a broken appointment fee

Appointments are reserved exclusively for you. As a benefit to you, our valued patient, we may offer to move your appointment to an earlier time if an opening should arise. We reserve the right to charge and collect $75.00 for any broken appointments. Broken appointments are considered those that are missed  
(no-show) or cancelled with less than 24 hour advance notice. 

Business Hours:
Mon: 8:00 AM - 5:00 PM
Tue:  8:00 AM - 5:00 PM
Wed: Closed
Thu: 8:00 AM - 5:00 PM
Fri:   8:00 AM - 2:00 PM 

 
*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.