Thank you for your interest in becoming a patient at the University of Michigan School of Dentistry. Please fill out the appointment request form and we will contact you within two business days to schedule your appointment.

* Required

First name *
Last name *
Phone Number *
(best number to reach you during the day)
Email Address *
Method of preferred contact
Phone
Email
Is there anything you would like us to know before we call you to schedule your appointment?
Note: Because email is not an encrypted messaging system, we cannot discuss Protected Health Information (PHI) via email. To discuss patient information that includes PHI, please call us at (734)763-6933. If you have a medical emergency, please dial 911.
How did you hear about us?
Please let us know how you heard about the UM School of Dentistry.