Request an Appointment with Flax Dental

I prefer to be contacted by: Select One Phone Email Are you a new Patient? Select One* Yes No

I would like to schedule a visit Select One Less than 1 month in 1 - 3 months in 3 - 6 months in 6 - 12 months in 12 months+ What time of day would you prefer? Select One Morning Mid-day Afternoon Preferred Payment Method Select One* Self Pay Dental Insurance Medicaid