Appointment Request | Brooklyn, New York | Smiles For Miles Pediatric Dentistry

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.

*Items in bold are required.

Name: Email: Phone:

Are you a current patient? Yes
No

Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Any TimeMorningNoonAfternoonEvening

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

Office Location

Brooklyn
1636 E. 14th Street Suite 114

Brooklyn, New York

11229

Map & Directions

Call: (718) 440-1288