Appointment Request

After you submit an Appointment Request in the form below, somone from our office will call you within the next 12 hours to confirm your visit to Briarcliff Dental Group.

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
Message
Describe the nature of your appointment or any other comments