Request an Appointment

If you are having a current dental issue that needs immediate attention, please CALL the main number for our clinic at (312) 321-7645. We will be able to assist more quickly by doing so.

Otherwise, please fill out the form below to request an appointment. A Dental Associates representative will be contacting you to schedule your appointment.

(Dental Associates will not share your information with outside parties.) Appointment requests are monitored and responded to during normal dental center business hours.


* Patient Type:
* First Name:
* Last Name:
* E-mail:
* Phone:
Reason for Appointment Request:
* Would you prefer us to contact you via SMS text message* to arrange your appointment?
* If Yes, please confirm your mobile phone number here:

* Standard rate and data charges may apply based on your cellular phone plan. We will never sell, rent, or trade your number with anyone, and we will only contact you via text message regarding your appointments, never for marketing purposes. Text messaging allows us to communicate with you more efficiently and provide you with better service. At the same time, please recognize that text messaging, by nature, is not a completely secure and encrypted means of communication.