Appointment Request

With the help of your Canton dentist and our easy-to-use form, scheduling an appointment with our office is now easier than it’s ever been! You can request the best date and time that works for you and we’ll be able to contact you and begin scheduling your preferred appointment. We know how much your smile means to you, so let us help in making your ideal smile a reality! Call our office at (330) 493-8400 if you have any questions.


Payment Information

We are committed to providing quality and affordable dental health care. You have multiple options for payment available. For your convenience, we accept cash, check, money order, major insurance, Visa, Mastercard, and Discover.


We understand that unexpected dental bills can sometimes strain finances. If this happens, talk with us immediately by calling us at (330) 493-8400. If you help us keep the lines of communication open, we can usually work out acceptable arrangements. We are pleased to accept CareCredit. 


Patient Information (* denotes fields that are required)
Patient Name*
Phone Number*
Email Address
Are you a current patient?
No Yes
Best time(s) to call?
Morning Noon Afternoon Evening
Appointment Information
Preferred Appt Date
Preferred Appt Time
Describe the nature of your appointment or any other comments