Request an Appointment

Please fill out the form below and we'll contact you to confirm your appointment.

First Name *

Please enter your first name

Last Name *

Please enter your last name

Email Address *

Please enter a valid email address

Phone Number *

Please enter your phone number

Date of Birth *

Please enter your date of birth

Patient Type * Select... New Patient Existing Patient

Please select patient type

Reason for Visit * Select... Routine Cleaning & Exam Toothache or Pain Cosmetic Consultation Dental Emergency Follow-up Appointment Other

Please select a reason for visit

Additional Information

Optional: Help us prepare for your visit

Preferred Date *

Please select a preferred date

Preferred Time * Select... Morning (8am-12pm) Afternoon (12pm-5pm) Any Time Available

Please select a preferred time

Preferred Dentist No Preference Dr. Mikaela Frazier Dr. Joanna Frazier

Optional: Leave blank if you have no preference

Do you have dental insurance? Yes No Not Sure

Insurance Provider

Policy/Member ID

Group Number

Policy Holder Name

Leave blank if you are the policy holder

Note: All insurance information is optional. We'll verify your coverage when you arrive for your appointment.

Please review your information before submitting:

Personal Information

Name:

Email:

Phone:

Date of Birth:

Patient Type:

Appointment Preferences

Reason:

Preferred Date:

Preferred Time:

Preferred Dentist:

Additional Info:

Insurance Information

Has Insurance:

I consent to Vantage Point Dental Studio contacting me via email or phone to confirm this appointment request. *

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