Appointment Request

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.

United Dental Office does not accept Japanese National Health Insurance.  Please do not request an appointment if you would like to use Japanese National Health Insurance.  Our fee for Limited Exam is 15,400yen and we will need other necessary x-rays and oral photoes to give you accurate diagnosis and do any treatment.

*Items in bold are required.

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

Preferred time(s) for an appointment?

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.

Many of the commonly asked question are answered in FAQ.  We appreciate if you read the FAQ first because contacting us for more details.  You can also call us if you have any question.

48 hours Appointment Cancellation Policy:  We make our appointment for the patient so they have minimum or no waiting.  We request any cancellation of appointment be made 48 hours before the time of appointment.  We reserve the time specifically to take care of you.  We will hold your appointment for 15 mintues.  If you are late and do not contact us, your time may be given for other patients.  If you cancel more than one time, there will be cancellation charge for missed appointment.   We will not be able to see you if you consistently cancel your appointment in the last minutes.