Appointment Request - Tufts Medical Center Residents

This form is specifically for Tufts Medical Center Residents looking to receive dental care at Tufts Dental School. To request an appointment or more information, please fill out the form below. Please do not submit sensitive information through this form.

First Name

Last Name

Phone Number

Request Details

Do you currently have a dentist?

Yes

Are you currently in pain?

Yes

Please tell us about your situation/request:

IMPORTANT! Please do not share sensitive personal information through this form.

Please tell us what days/times might work best with your schedule: