Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone (415-668-1155) or complete the appointment request form below. Our scheduling coordinator Cindy will contact you to confirm your appointment. It will be a pleasure to see you! Please be informed that Dr. David Yee will be retiring at the end of September and Dr. Ryan Chiu will assume providing excellent dental care for you!

If you are a new patient, please help us to offer you optimum dental care by filling out our office forms and bringing them to your first visit. 

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


Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
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.