Appointment Request

Call Us: (973) 743-5116 Request Appointment New Patient Form

Bloomfield Dentist Appointment - The Dental Center Family Practice

The first step towards a beautiful, healthy smile is to schedule a Bloomfield dentist appointment. We proudly serve Bloomfield, Montclair and the entire New Jersey community. Please contact our dental office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your dental appointment.

Please do not use this form to cancel or change an existing appointment.

*Items in bold are required.
Are you a current patient?


Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

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.

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