Dental Appointment Request

Thank you for your interest in Harrison & Bethke Family & Cosmetic Dentistry. Filling out this form does not mean your appointment will be scheduled at the requested time. We hope to be able to accommodate your requested time but will need to verify an opening on our appointment calendar. We will contact you as soon as possible after receiving the request to confirm an appointment time with you. If you are experiencing a dental emergency and need assistance immediately, please call us at 281-492-6064. Thank you for contacting us!

Your Name*

Your Email Address*

Phone Number*

Preferred Date

Preferred Time

Service Requested

Select a service... Broken Tooth Check-up and Cleaning General Consultation Jaw and/or Joint Pain (TMJ) Second Opinion Teeth Whitening Toothache Veneers Other

Additional Questions or Comments Related to Your Appointment?*

Submit

Map to Harrison & Bethke

If you have any questions about how to get to our office, please call us at 281-492-6064. We look forward to meeting you.