Appointment Request For express service, please use this form to book an appointment. We will confirm your appointment as soon as humanly possible. Name* First Last Phone*Email* Dental care required*Consultation/ExaminationCheckupFilling(s)Extraction(s)Cleaning/Teeth WhiteningDenture(s)OrthodonticsWhich location*West Coast (Atlantis) - 021 572 6802Date* MM slash DD slash YYYY Time* : Hours Minutes AM PM AM/PM Special Instructions Δ