Request an Appointment

The first step toward achieving a beautiful, healthy smile is to schedule an appointment. To schedule an appointment, please complete and submit the request form below. A referral from a general dentist is not required to schedule a consultation at Icon Orthodontics.

Please note this form is for requesting an appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly.

    Patient Name *

    Parent Name

    Email *

    Phone *

    Preferred Location *

    Type of Appointment

    How did you hear about us? *

    Comments

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