ADA Accessibility Information
Accessibility
A
A

A
Surprise Smiles Logo
Request an Appointment Button
Facebook Button Google Read Reviews Button
Surprise (602) 842-4864
Prescott Valley (928) 277-0076
Prescott (928) 443-1200

Request an Appointment

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: *

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:

 

Confirmation

How do you prefer to be contacted?: *

  Email   Phone  

 
 

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

 
OUR PHILOSOPHY

Our Family Cares for Everyone in Your Family

Family Graphic Image
Surprise Smiles Logo
Get the Smile You've Always Wanted!

Surprise Smiles
15128 W Bell Rd, Suite 12
Surprise, AZ 85374
(602) 842-4864

Prescott Valley
7136 East Pav Way
Prescott Valley, AZ 86314
(928) 277-0076

Prescott
172 E Merritt St.
Suite F
Prescott, AZ 86301
(928) 443-1200

Request an Appointment Button

Sign Up for E-Newsletter Button




Copyright © 2015-2023 Surprise Smiles and WEO Media (Touchpoint Communications LLC). All rights reserved.  Sitemap
Request an Appointment Online - Surprise, AZ • Surprise Smiles
At Surprise Smiles, we make it easy to request your appointment online. Click to access our secure appointment form, and we'll get in touch with you to confirm.
Surprise Smiles, 15128 W Bell Rd, Suite 12, Surprise, AZ 85374-2451 \ (602) 842-4864 \ surprisesmilesdental.com \ 6/4/2023 \ Page Keywords: Dentist Surprise AZ \