Please use this form to request a convenient time for your visit to our Downtown Fort Collins office. We will be in touch soon to confirm the details of your appointment and answer any questions you may have.

 

Please Complete All Fields

 

Full Name:

 

Phone Number:

 

Email Address:

 

Do you prefer to see a particular dentist?
Dr. Michael “Mick” McDill, DDS
Dr. Todd Rosenzweig, DDS, MDS
Dr. Mesa Roth, DDS
No preference

 

Is there a specific date that you would prefer?

/

/

 

What day of the week would you like to come in?

Monday / Tuesday / Wednesday / Thursday / Friday

 

What time do you prefer?
7:30 a.m. – 12:30 p.m. / 1:30 p.m. – 4:30 p.m.

 

Please briefly describe the reason for your visit:
(Please do not submit any sensitive or medical information using this form.)

 

How did you hear about us?
Referral from friend or family member / Google /
Online Directory / Phone Book / Other
If other please describe:

Company Email:

 

 

Alpine Dental Health in Downtown Fort Collins

718 South College Avenue
Fort Collins, CO80524

Phone: (970) 484-5297

Email: fortcollins@alpinedentalhealth.com

Click here for map and directions. Please call us if you need help finding our office!