Make an Appointment

Please fill out the *required information and our team will be in contact shortly to confirm your appointment. We look forward to seeing you in our dental office soon.

Our form submission is 100% Secure and Certified using 256-bit encryption. We strictly follow HIPAA protocols when it comes to your private information, both in the office and online.

Appointments may also be made by calling our front desk to coordinate schedules.

Call: (913) 469-8019

ShowYourGrin.com Appointment Request

* Patient Name: (Required)

Date of Birth:

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* E-mail: (Required)

* Phone Number: (Required)

I allow the North Dentist Office to contact me through text messages.

Reason for Visit

Select up to 3 preferred appointment dates & times.

Preferred Day - 1st Choice:

Preferred Time:

Preferred Day - 2nd Choice:

Preferred Time:

Preferred Day - 3rd Choice:

Preferred Time:

How did you hear about our dental office?

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