Appointment Request

Office Hours

Monday: 8:00am - 4:00pm
Tuesday: 10:00am - 8:00pm
Wednesday: CLOSED
Thursday: 8:00am - 4:00pm
Friday: 9:30am - 3:30pm
Saturday: 8:00am - 3:00pm
Sunday: CLOSED

*Office hours are subject to change - please call ahead if you are stopping in as an emergency*

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

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

*Items in bold are required.

Name: Email: Phone:

Are you a current patient? Yes
No

How did you hear about us?

Which office location(s) would you prefer for your appointment?

Mississauga 3050 Artesian Drive Unit 10

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

Any DayMondayTuesdayWednesdayThursdayFriday

Preferred time(s) for an appointment?

Any TimeMorningAfternoon

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.

Churchill Smiles Dentistry

3050 Artesian Drive, Unit 10, Mississauga, Ontario L5M7P5

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