Gary M. Palsis, DMD
Professionalism you can Trust!
Call: (321) 773-7400

Appointment Request

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.

Please do not use this form to cancel or change an existing appointment.
*Items in bold are required.
Are you a current patient?


Which office location(s) would you prefer for your appointment?


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

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

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

Testimonials

4/6/17 First, thanks for your many years of faithful service & getting me through the rough times. I am writing in appreciation of your support staff - for their caring & professional help. Kudos to you & your staff!!

Martha

3/21/17 Thank you, Dr Palsis! My son was very comfortable with you - as I think you could tell!

Barbara

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