Request appointment

Complete the form below and our friendly staff will contact you to confirm your child’s appointment or give us a call at 402.397.3377. We look forward to seeing you!

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First Name*

Last Name*

Email*

Phone Number*

First Name*

Last Name*

Patient Birthday

Preferred Day of Week*

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Monday

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Wednesday

Thursday

Friday

Preferred Time of Day*

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Dental Need

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HOURS
Monday 8:00am-5:00pm
Tuesday 8:30am- 5:00pm
Wednesday 8:00am-5:00pm
Thursday: 8:00am-5:00pm
Friday: 8:00am-12:00pm

HOURS
Monday 8:00am-5:00pm
Tuesday 8:30am- 5:00pm
Wednesday 8:00am-5:00pm
Thursday: 8:00am-5:00pm
Friday: 8:00am-12:00pm