Accessibility Driving Directions Contact Us

Appointment Request Call (626) 480-1543

Kanoknuch S. Shiflett, DDS

Pediatric Dentistry and Orthodontics

Creating Beautiful Little Smiles

Call (626) 480-1543

Menu

Appointment Request

Home

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.

Office Hours
Monday - Friday
8:00AM - 5:00PM

Please do not use this form to cancel or change an existing appointment.

---

Patient Information

NamePlease enter your name

EmailInvalid Email address

PhonePlease fill in phone or email address!

Are you a current patient?YesNo

How did you hear about us?

Patient Availability

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

Preferred time(s) for an appointment? Any TimeMorningAfternoon

Reason For Visit

Please describe the nature of your appointment?

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

This is the best pediatric dentistry. They have provided great service and care for my kids.

Ready for your first appointment?