Appointment Request

San Francisco Dental Appointment Request
San Francisco Dental Office - Pacific Dental Care 

The first step in achieving a beautiful smile is scheduling a dental appointment.  Please use the appointment request form below and our scheduling coordinator will be in touch via phone to confirm your appointment.  If you prefer to speak with someone directly, call our San Francisco dental office at (415) 923-3034 to schedule your appointment and confirm it immediately.

*Note: This form is for requesting appointments only.  Please do not use this form to change or cancel a pre-existing appointment.

Patient Information




Are you a current patient?  Yes   No

Patient Availability

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


Preferred time(s) for an appointment?


Want to see Doctor

 Dr. Stafford Duhn
 Dr. Anisha Kahai
 Dr. Irene Chen 
 Dr. Christopher Duhn
 Dr. Debra Westervelt
 No Preference


Reason For Visit

Please describe the nature of your appointment?

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