Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.

Patient Information

Name

Phone

Are you a current patient?YesNo

How did you hear about us?

Patient Availability

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

Preferred time(s) for an appointment? Any TimeMorningAfternoon

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.

26597 N. Dixie Highway|Perrysburg, OH 43551|MAP & Directions

Call: (419) 872 3000

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Appointment Request

Perrysburg, Ohio Dentist, Dr. Rimple Grewal is dedicated to family dentistry such as Exams, Teeth Whitening, Veneers and more.

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