Appointment Request

    Fields marked with * indicate required information. All other fields are optional.

    *Patient Type

    I am a CURRENT patient.I am a NEW patient.

    *First Name

    *Last Name

    City

    State

    *Phone Number

    *Email

    Please describe your symptoms.

    Complete the form and you will be contacted shortly to verify the appointment

    Our office is open Monday through Friday, with hours that can accommodate most any schedule. We know that your time is important, and we work to ensure your visit is scheduled as professionally and quickly as possible.
    Monday 8:00 am – 5:00 pm
    Tuesday 8:00 am – 5:00 pm
    Wednesday 8:00 am – 5:00 pm
    Thursday 8:00 am – 5:00 pm
    Friday 8:00 am -12:00 pm

    Emergency and After Office Hours:

    We know dental emergencies are never convenient or timely and we are commited to our patients’ health no matter the time.  If you are a current patient, and have a dental emergency after regular office hours, please call us at 850.932.2266.

    Important Information Regarding COVID-19

    Patients,

    We are happy to welcome you back to the office as we reopen under the guidelines surrounding this unprecedented pandemic. Hygiene and safety have always been a priority at our office and we will be taking additional measures to ensure the safety of our patients and staff during this time.  Here are a few of our current in office changes and guidelines:

    1. Any patient experiencing flu-like symptoms or fever, feeling sick or that has been exposed to anyone suspected to have been exposed to COVID-19, please reschedule your appointment and please do not enter the office.
    2. When coming in for an appointment, you will be greeted upon your arrival by one of our staff members at the front door who will take your temperature and ask a few pre-screening questions before bringing you directly to the treatment area.
    3. For your safety and the safety of our other patients, we strongly prefer for anyone accompanying a patient to wait in the car during the exam unless absolutely necessary. Caregivers and guardians assisting patients with special needs are welcome to accompany the patient to the treatment area, but we prefer they wear a facial covering.
    4. For new patients under 18, one parent may accompany the patient into the office. 

    Our staff and patients are our family, and we are doing everything we can to keep our family safe.  We thank you for your understanding and patience and look forward to seeing you again very soon!

    Dr. Gibson, Dr. Zieman & Dr. Heath