Emergency Dentist Appointment Request

Schedule an Emergency Dental Appointment with Shamblott Family Dentistry

See How we are Handling Emergency Appointments due to Coronavirus

Make an Emergency Dental Appointment Right Now and Get out of Pain Today!

Emergency Dentist Appointment Needed for broken tooth, dentist, pain, fear, frustration

If you have a Dental Emergency, call 952-935-5599 to make an Emergency Dental Appointment, or fill out the form below and we’ll call you when you tell us it is convenient to do so.

To request dentist appointment availability, please fill out the form below. This does NOT guarantee or confirm your appointment.
Our scheduling coordinator will contact you to confirm your appointment. Thank you.

This form cannot be used to postpone, cancel or re-schedule an existing appointment. To make changes to an existing appointment, please call 952-935-5599

Subject (required)

First Name and Last Name (required)

Your Email (required)

Address

City

State

Zip

Work Phone Number

Home Phone Number

Preferred Phone Number/ Please contact me at this number (Required)

Best Time to Reach Me

Choose your preferred appointment time
MorningMid-dayAfternoonEveningSaturdayAny

Preferred Appointment Date and Time (For Example: 02/18/2014 9:00AM)

Preferred Location
Hopkins OfficeSt. Paul OfficeNo Preference

Please list any special concerns or anything you want us to know:

How did you hear about us?

Google SearchOnline AdvertisingTV CommercialRadio CommercialLive TV AppearanceExisting Patient/EmployeeSocial Media (Facebook, Twitter, Instagram)Other