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Request an Appointment

Home / New Patients / Request an Appointment

[fullwidth background_color=”” background_image=”” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ background_repeat=”no-repeat” background_position=”left top” video_url=”” video_aspect_ratio=”16:9″ video_webm=”” video_mp4=”” video_ogv=”” video_preview_image=”” overlay_color=”” overlay_opacity=”0.5″ video_mute=”yes” video_loop=”yes” fade=”no” border_size=”0px” border_color=”” border_style=”” padding_top=”20px” padding_bottom=”20px” padding_left=”0px” padding_right=”0px” hundred_percent=”no” equal_height_columns=”no” hide_on_mobile=”no” menu_anchor=”” class=”” id=””][two_third last=”no” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_size=”0px” border_color=”” border_style=”” padding=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”” animation_speed=”0.1″ animation_offset=”” class=”” id=””][fusion_text]

    Please tell us about your appointment preferences and a member of our staff will contact you with scheduling options or appointment confirmation.

    Patient's first and last name (required)

    Birthdate (required for positive identification)

    Your Email (required)

    Primary Phone Number

    What is the purpose of the appointment?

    How soon would you like to come in?

    Preferred Day(s)
    MondayTuesdayWednesdayThursdayFriday

    Preferred Time
    8:00-am-12:00pm12:00pm-3:00pmAfter 3:00pmAnytime

    Please type the characters you see below:
    captcha

    [/fusion_text][/two_third][one_third last=”yes” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_size=”0px” border_color=”” border_style=”” padding=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”” animation_speed=”0.1″ animation_offset=”” class=”” id=””][imageframe lightbox=”no” gallery_id=”” lightbox_image=”” style_type=”none” hover_type=”none” bordercolor=”” bordersize=”0px” borderradius=”0″ stylecolor=”” align=”none” link=”” linktarget=”_self” animation_type=”0″ animation_direction=”down” animation_speed=”0.1″ animation_offset=”” hide_on_mobile=”no” class=”” id=””] [/imageframe][separator style_type=”single” top_margin=”10″ bottom_margin=”20″ sep_color=”#00529b” border_size=”” icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”” class=”” id=””][title size=”2″ content_align=”left” style_type=”underline solid” sep_color=”” margin_top=”” margin_bottom=”” class=”” id=””]Contact Us[/title][fusion_text]Phone:  603.692.9229

    263 Route 108
    Somersworth, NH 03878

    Fax: 603-692-5850[/fusion_text][separator style_type=”single” top_margin=”10″ bottom_margin=”20″ sep_color=”#00529b” border_size=”” icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”” class=”” id=””][/one_third][/fullwidth]