Request an Appointment

To request an appointment at Texas Dental Surgery, please take a moment to fill out the short form below. Indicate when you are available and be sure to click “submit” when you’re done. Afterward, our team will contact you within a day or so with a list of available timeslots based on your answers. Select the one that is best for you, and you’ll be all set for your visit. We look forward to meeting you, and please let us know if you have any questions beforehand!

Full Name Jane Doe Phone Number (555) 555-5555 Email Address jane@doe.com

Are you... A New Patient An Existing Patient

Preferred day of the week Monday Tuesday Wednesday Thursday Friday

Preferred time of the day Morning Afternoon

How did you hear about us? Select One Search Engine Family/Friend Promotion Social Media Other

Submit Request