Request an Appointment Thank you for your interest in Poplar Crossing Dental. Please fill out the form below and one of our staff members will set up a date and time convenient for you.We take measures to ensure that your privacy is protected. Please read our privacy policy for more information.Name* First Last Email* Enter Email Confirm Email Address* Street Address City ZIP / Postal Code Phone*What search term did you use to find this website?*Best time to call:MorningAfternoonEveningPreferred days and time for the appointment:Please tell us the reason for your visit, or if you have any questions or concerns about your dental health that you would like addressed during your visit.Are you a new patient?*YesNoDid you check any online reviews to help you pick our dental office?YesNoHave you looked at our practice Facebook page yet?YesNoWould you be interested in participating in a short survey by telephone? If selected, you will receive a $10 check for your participation. Yes I would NameThis field is for validation purposes and should be left unchanged.
