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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.

Within the comment section BELOW, please provide your INSURANCE information and type of plan (i.e. PPO, DHMO, and MEDICAID). We unfortunately, do NOT accept DHMO nor MEDICAID, however, we would still be happy to see you as an uninsured patient within our practice.


Patient Information

Patient Availability

Reason For Visit

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

Connect With Us

Ready to come in for an appointment?
Contact us today!

Urbandale Family Dentistry
3124 104th St
515-276-7925

Urbandale Family Dentistry is a dental practice dedicated to General, Family & Cosmetic Dentistry with services including Dental Exams, Dental Makeovers, Teeth Whitening, Veneers, Crowns, X-rays, Fluoride, Cleanings, & more. Please come and visit Urbandale, IA dental practice Urbandale Family Dentistry.


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