Request an Appointment
for Cosmetic Dentistry

Serving Santa Rosa and San Francisco, California

Ready to schedule an appointment about cosmetic dentistry with Dr. Klim? You may use the form below to provide us with contact information, and to specify your preferred appointment date and time. A staff member will contact you to confirm your appointment and collect more information.

If you prefer, you may call 707-544-SMILE (7645) to schedule an appointment.

Request a Cosmetic Dentistry Appointment

PLEASE NOTE: FIELDS IN RED ARE REQUIRED.

CONTACT INFORMATION
   
Title
First Name
Last Name
Address
City
State
Zip
Country
Daytime Phone
Evening Phone
Email

APPOINTMENT PREFERENCES

URGENCY:

How immediately would you like us to try to fit you in?

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

Your notes about appointment urgency...

DAY/TIME: 1st CHOICE

What day of the week would be best for your appointment?

Monday
Tuesday
Wednesday
Thursday

What time of day would be best for your appointment?

early morning
late morning
lunch
early afternoon
late afternoon
DAY/TIME: 2nd CHOICE

And your second choice if your first choice of day is not available?

Monday
Tuesday
Wednesday
Thursday

And your second choice if your first choice of time is not available?

early morning
late morning
lunch
early afternoon
late afternoon

Is there any other information you would like to share with us about your desired appointment?

ADDITIONAL INFORMATION

If you have one, who is your regular dentist?

Name
Phone

Have you ever had cosmetic dentistry work before?


How did you hear about Dr. James Klim?


If your answer to the above was a referral, whom may we thank?


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Oct 26, 2007
Dr. Klim Lecture: CEREC Can Be What You Want it to Be

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An array of choices are available for you to make your smile sparkle with modern cosmetic dentistry.

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This site is for informational purposes only and should not be construed as medical advice. Dr. James Klim is a California cosmetic dentist who provides dentistry for the Santa Rosa and San Francisco, CA area. Also serving patients from the Napa, Oakland, Marin, Petaluma, Sonoma, and Vellejo areas.