Request an Appointment

Please fill out the form below and let us know your preferred dates and times for an appointment. We will do our best to fit you in as close to those as possible.

    Name:
    Email:
    Phone:
    Address:
    Preferred time(s) to call?:
    MorningNoonAfternoonEvening
    Preferred day(s) of the week for an appointment?:
    Any DayMondayTuesdayWednesdayThursdayFriday
    Preferred time(s) for an appointment?:
    Any TimeMorningNoonAfternoonEvening

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

    New Patient Online Offer

    Free second opinion ($125 Value)

    Contact us today for details

    Phone: 717-235-3871

    Address: Southern York Smile Care 4 S Main St Shrewsbury PA 17361