Appointment request forms can be submitted 24 hours a day. We review requests from 8:00 AM - 4:30 PM, Monday - Friday. Appointments will be made based on availability. Your appointment is NOT confirmed until you've received an email or phone call from one of our office assistants. All information submitted will be treated as highly confidential. If this is an emergency, call our office at 479.484.7645.
Step 1 : Enter your patient and contact information
Patient Name:
Parent or Guardian: (if patient is under 18)
Patient's Date of Birth:
Phone Number:
Preferred Time To Be Called:
E-Mail Address:
Are you a new patient?
Yes, I am a new Eastpoint Dental Clinic patient No, I am an existing Eastpoint Dental Clinic patient
IMPORTANT: If you are a new patient, please download and fill out the new patient form located on the Download Patient Forms page
Step 2 : Briefly describe your dental needs
All information submitted will be treated as highly confidential.