Appointment Request


If you would like to make an appointment, please contact our office by phone at (540) 774-5900 or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

We will schedule your appointment as promptly as possible.  If you have pain or an emergency situation, every attempt will be made to work you into our schedule that day. 

We try our best to stay on schedule to minimize your waiting.  Due to the fact that Valley Oral Surgery provides surgical services, various circumstances may lengthen the time allocated for a procedure.  Emergency cases can also arise and cause delays.  We appreciate your understanding and patience. 

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

Items in bold are required.
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.