Request an Appointment - Oral Medicine

Patient First Name

Patient Last Name

Phone Number

Has patient received care at Tufts Dental School before?

Yes

Are you requesting appointment on behalf of someone else?

Yes

Request Details

What is the best time(s) to call you?

Morning

Afternoon

Evening

How did you hear about us?

Please tell us about your request:

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