Request a Consultation Appointment

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 set up your consultation appointment.

Please do not use this form to cancel or change an existing appointment. If you need to do so, please call our office directly at 951-679-6822, or fill out the contact form on our Home page. Thank you!

Contact Us

FIRST NAME

LAST NAME

ADDRESS

Address2

City

State

Zipcode

PHONE

Are you or the person you are scheduling a brand new patient to our office?

Yes

Name of patient(s) to be scheduled:

Best time(s) to call?

Morning

Afternoon

Preferred day(s) of the week for a consultation?

Tuesday

Wednesday

Thursday

Preferred time of day for a consultation?

Early morning: 6AM, 7AM, 8AM

Late morning: 10AM, 11AM

Early afternoon: 1:30PM, 2:30PM

Late afternoon: 3:30PM, 4:30PM

Please tell us about your concerns:

Thank you for contacting us.
We will get back to you as soon as possible.

Oops, there was an error sending your message.
Please try again later.

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

Share by:

Request a Consultation Appointment

Contact Us

ERICKSON ORTHODONTICS © 2023