Appointment Request | Mitchell, SD | Timothy M. Drake, DDS

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(605) 996-9235

Timothy M. Drake, DDS MAGD

Excellence in Family Dentistry

Creating Beautiful Smiles

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Call: (605) 996-9235

(605) 996-9235

(605) 996-9235

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.

*Items in bold are required.

Name: Email: Phone:

Are you a current patient? Yes
No

How did you hear about us?

Which office location(s) would you prefer for your appointment?

Mitchell 103 W. 12th Avenue

Preferred day(s) of the week for an appointment?

Any DayMondayTuesdayWednesdayThursdayFriday

Preferred time(s) for an appointment?

Any TimeMorningNoonAfternoonEvening

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone at (605) 996-9235 if sending highly confidential or private information.