accessibility ACCESSIBILITY
Appointment Request
Thank you for your interest in our services. Please contact our office by phone at 951-679-9355 or complete the appointment request form below.  One of our team members will contact you to confirm your appointment. We respect the fact that you can select from a number of local dentists, but we are confident you will be happy that you selected Dr. Kennedy and our terrific team.

Please do not use this form to cancel or change an existing appointment.
Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
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.