ADA Accessibility Information
Accessibility
A
A

A

Request an Appointment - Huntington

Please fill out the form below and we will contact you with an appointment time. Required fields are marked with asterisks (*).

Patient Information

Name: *

Phone: *

Email address: *

Name of insurance company:

 

Have you visited our office before? *

Yes No  

What is the reason for the appointment? *

  Regular Exam / Cleaning
  Specific Concern / Procedure

What concerns, if any, would you like to speak to the doctor about:

How do you prefer to be contacted? *

  Email   Phone  

Confirmation

 
 

It may take a moment to submit your information. Please wait for a confirmation message.

 
Logo for Summit Dental Group






Copyright © 2021 Summit Dental Group and WEO Media (Touchpoint Communications LLC). All rights reserved.  Sitemap | Links
About Us Fort Wayne, IN • Summit Dental Group
Above all else, our Dentists and professional team here at Summit Dental Group want our patients to maintain healthy, bright, and beautiful smiles!
Summit Dental Group, 9121 Illinois Road, Fort Wayne, IN 46804 / 260-297-7081 / summitdentalgrp.com / 10/22/2021 / Associated Words: dentist Fort Wayne IN / dentist Fort Wayne IN /