Request an Appointment

The first step toward achieving a beautiful, healthy smile is to schedule a complimentary orthodontic exam with Dr. Reynolds.  Please complete and submit the request form below.  If you are a current patient requiring assistance, let us know what type of appointment is needed.

Please note this form is for requesting an appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly.

Patient Name *

Parent Name


Phone *

Type of Appointment

Preferred Location *

Preferred Date *

Preferred Time *