YourSmile Dentistry

Dr. Sha Tao, D.M.D.
Creating Beautiful Smiles For You

Appointment Request

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The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone (972-335-5455) 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.

*Items in bold are required.

Name:
Address:
City:
State/Province:
Zip/Postal:
Email:
Phone:
Are you a current patient?	Yes   No
Best Time to call	Morning   Noon   Afternoon   Evening
Preferred day(s) of the week for an appointment
Any Day   MON   TUE   THUR   FRI   SAT
Preferred time(s) for an appointment
Any Day   Morning   Noon   Afternoon   Evening
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.