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Appointment Request Form

The first step toward achieving a beautiful, healthy smile is to schedule an appointment. To schedule an appointment, please complete and submit the request form below. Our scheduling coordinator will contact you soon to confirm your appointment.

Please note this form is for requesting an appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly.

Contact Information:

Bold fields are required.

Please provide the patient's name

 
Appointment Preferences:

Which day(s) of the week are you available?

Which time(s) of the day are you available?


 
Wilkinson Orthodontics rewards

Get Rewarded

Successful orthodontics is a team effort and YOU are our key player! We've created our Ortho Bucks and Kids Club Rewards Programs to recognize your accomplishments and congratulate your winning achievements. These are incentive programs based on your compliance.
You set the bar… every visit is an opportunity to earn ortho bucks for cool prizes.

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Changing Smiles

Changing Lives

Nominate a child or adult to get free braces

We choose two exceptional individuals to receive complimentary, full orthodontic treatment. Our winners are chosen based upon letters of recommendation by their friends and loved ones describing their need, character, and how they have helped others in need, plus a personal interview with our team members.

[more details]