Please fill out the form below with the information required to set up an appointment. After completing this form, you will receive a call from our direct line at 905-568-1200 or a text from our SMS line at 366-501-2007. Name * First Name Last Name New/Existing Patient * New Existing Phone Number * Preferred Contact Days Please select the day(s) that work best to reach you. Monday Tuesday Wednesday Thursday Friday Saturday Preferred Contact Time Please select the time(s) that work best to reach you. Morning Afternoon Evening Comments or Questions Please let us know any comments or questions you may have regarding Century City Dental so we can best serve you. Do you agree to opt-in to receiving text messages about appointments from Century City Dental? You can opt-out by texting "STOP" at any time. YES - Opting in NO - Opting out Thank you for requesting an appointment! Our office will contact you on the date and time requested, or within the next 24 hours.
