Call us at:  561-736-2377
650 W. Boynton Beach Blvd., Suite 1, Boynton Beach, FL 33426

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Request An Appointment At Palm Beach Smiles

We are looking forward to meeting you!  Please fill out the form below to request an appointment at our Boynton Beach dental office.  We will get back with you as soon as possible.

If you need to reschedule an existing appointment, or if you have a dental emergency, please call us at 561-736-2377

Click here to download our New Patient Registration Forms and save time by filling them out at home!

Please provide the following contact information:

Name (required)  
Phone (required)  
E-mail (required)  

Select preferred days of week for appointment:
(multiple selections allowed)

Monday
Tuesday
Wednesday
Thursday

Preferred time of day:
(optional)

AM
PM

Do you have a specific date in mind?
(optional)

-- mm/dd/yy

What kind of appointment do you need?
(you can select more than one)

New Patient Comprehensive Exam
Cleaning
Urgent Problem (broken tooth, toothache, other)
Cosmetic Consultation
Invisalign Consultation
Six Month Braces Consultation
2nd Opinion

Please let us know anything else you feel is important about your first visit.

How did you find this website?

Web Search Engine (Google, Yahoo, MSN, etc.)
Facebook
Twitter
Advertisement
A friend or relative told me.
I am an existing patient.
Other:

Thank you for taking the time to fill this form.  We'll be in touch soon!

 

Click here to download our New Patient Registration Forms and save time by filling them out at home!

General Dentist Serving Boynton Beach, Delray Beach, Boca Raton, Lake Worth, West Palm Beach, and the extended Palm Beach County areas.

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Copyright 2017 Michael I. Barr, D.D.S., All Rights Reserved