For your convenience, we will try to arrange your office visits for times that fit your schedule. For routine dental services, cleanings, or for a consultation for reconstructive or cosmetic dentistry, please use this form to request an appointment.

Note: If you have a dental emergency, please call (630 971-0682) at any time,
night or day.

Please complete as much of this form as possible, then click Request Appointment button at bottom of page.

*** IF YOU ARE A NEW PATIENT, PLEASE CLICK HERE TO FILL OUT THE HEALTH QUESTIONNAIRE PRIOR TO REQUESTING      AN APPOINTEMENT***


Request an Appointment
Name:  
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Phone:  
    
Comments:

Please note reason for appointment. Be as specific or general
as you like.(i.e. --"I NEED A CLEANING" or "I would like to
discuss options for fixing my teeth", etc...)
   
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Ronald L. Schefdore, DDS is licensed as a general dentist in the state of Illinois providing cosmetic dentistry procedures.
Copyright © 2004 Ronald L. Schefdore, DDS. All rights reserved.