We are currently accepting new patients! Please fill out the information below, and one of our team members will contact you to schedule an appointment. We look forward to seeing you soon. Appointment Request - GalliaFamilyDental * Name (Required)Have you been to our office before?Yes No Phone numberPreferred contact method?Call Text Reason for visit? (Cleaning, broken tooth, toothache, etc.)Do you have dental insurance? What type?Preferred day/time for appointment? How did you hear about our practice?Select an OptionAdvertisementA FriendInternetStaff MemberYellow PagesOtherHow did you find our website?Select an OptionAdvertisementA FriendSearch EngineOtherComments Security Measuregoogle recaptcha