NameThis field is for validation purposes and should be left unchanged.Name*PhoneConsent By submitting this form and signing up for texts, you consent to receive recurring appointment reminders, billing and account information, and promotional text messages from Vineyard Dental Group at the number provided, including messages sent by autodialer. Consent is not a condition of purchase. Msg & data rates may apply. Msg frequency varies. Unsubscribe at any time by replying STOP. Reply HELP for help. Privacy Policy & Terms and Conditions.Email* Preferred Date MM slash DD slash YYYY Preferred TimeMorningAfternoonEveningMessage*Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!
