Atlanta Dental Center
Dentistry People Want
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Request an Appointment Online

Serving the Altanta Metro and Midtown area for 25 Years

To request an appointment please fill in the form provided below and click the submit button. Once we recieve the form and have a chance to check if the date and time you requested is open we will have a staff member contact you to confirm that your appointment is scheduled.

If you prefer scheduling over the phone, please call us at 404-872-7755.

Request Appointment Form

Note: fields in red are required.
CONTACT INFORMATION
Title
Name
Address
City
State
Zip
Country
Daytime Phone
Evening Phone
Email
APPOINTMENT PREFERENCES
URGENCY
DAY/TIME: 1st CHOICE
DAY/TIME: 2nd CHOICE
How urgently would you like us to try to fit you in?

Emergency
As soon as possible
Within two weeks
Within a month
No rush

Any comments or notes about the urgency...

What day of the week is best for you?

Monday
Tuesday
Wednesday
Thursday
Friday

What time of the day is best for you?

early morning
late morning
lunch
early afternoon
late afternoon

 What is your second choice for day of the week?

Monday
Tuesday
Wednesday
Thursday
Friday

What is your second choice for time of day?

early morning
late morning
lunch
early afternoon
late afternoon
Is there any other information you need to tell us about your appointment time and day?

ADDITIONAL INFORMATION
Who is your regular dentist, if you have one?

Name
Phone

Have you ever had cosmetic dentistry before?
How did you hear about us?
If your answer above is from a referral, then whom may we thank?
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CALL NOWBook Online
"I decided to do something about my dental problems and asked Dr. Benk for help. He helped me achieve my goal."
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We provide general dental care and cosmetic dentistry with the use of the latest advances in technology.
620 Peachtree Street, Ste 204, Atlanta, GA 30308
404.872.7755 | APPOINTMENTS
© 2009 ATLANTA DENTAL CENTER
ALL RIGHTS RESERVED | TERMS OF USE | SITEMAP
 Georgia Dental AssociationCEREC by Sirona
AACD - American Academy of Cosmetic DentistryZoom! Whitening
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This website is for informational use only and should not be used as medical advice, nor is intended to be used as such. Statements on this website are given only to help in making the choice to choose our office as your general dentist or/and cosmetic dentist and provide our contact information.