Appointment Request for Fidel Valdez, D.D.S., D.D.S.O.

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 provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
Zip/Postal Code
Work Phone
Home Phone

Are you a current patient?

Yes No

Best time(s) to call?

Morning    Noon       Afternoon  Evening  

Preferred Day(s) of the week

ANY DAY  MON      TUE      WED    
THUR     FRI      SAT      

Preferred time for an appointment?

Any Time   Morning    Noon       Afternoon

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

Copyright 2012 Global Village Communication. All rights reserved.
Revised: 10/20/15