Appointment Request

Savage Smiles Appointment Request Form

You can make your appointment by either calling the office at 480-334-5402 or making your appointment request on-line below.

* Required information.

For submitting your data don't fill this following email field:

Today's Date *
First Name *
Last Name *
Best phone number to reach you: *
email address *
Are you a current patient of Dr. Savage?
What day & time would you like to request your appointment for? *Please refer to the schedule on the right hand side of this page for our hours.
Appointment Date Requested (First Choice)
Appointment Time Requested (First Choice)
Appointment Date Requested (Second Choice)
Appointment Time Requested (Second Choice)
Appointment Date Requested (Third Choice)
Appointment Time Requested (Third Choice)
Please solve the simple math problem as our captcha and then hit send.