Fill in the form below for requesting a new dental appointment. If you need to re-schedule and appointment, please call our office during normal working hours. Request an Appointment Please Provide Your Contact Information First Name* Last Name* Phone Number* Your Email* Best time to call* MorningAfternoonEvening Are you a patient of ours? I'm a current patient I'm a new patient Briefly explain your dental needs: What days do you prefer for your appointment? Monday Tuesday Wednesday Thursday Select the time of day that is best for you: Morning Afternoon Anytime How did you find us? Typed in website url (www.fairwaydental.com)Found you in yellow pagesA friend told me about youA directory listing (i.e. YellowPages.com, Yelp.com, etc.)I entered a search term in Google, Yahoo or Bing.