Go back to Home Schedule An Appointment Schedule an Appointment 305 W. 12th Ave.Columbus, OH 43210614-292-1472 Directions and FREE PARKING information Schedule an Oral Surgery Appointment To schedule an appointment, please complete the form below or call 614-292-1472 and select option 2 for scheduling. Cancellations: We would appreciate 24 hrs notice for any cancellation. This allows other patients to fill your vacancy. More information about your first visit and new patient forms. You must have JavaScript enabled to use this form. Patient status (Required) I am a new patient I am an established patient Name First (Required) Middle Last (Required) Date of Birth (Required) Date of Birth: Month (Required) MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Date of Birth: Day (Required) Day12345678910111213141516171819202122232425262728293031 Date of Birth: Year (Required) Year2023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924 Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Email (Required) Phone (Required) Preferred method of contact (Required) Phone call Text message Email Hours:We are available to see patients Monday – Friday, 7:30 a.m. to 4:30 p.m. Choose three preferences for your appointment: Schedule of preferences Day Morning Afternoon Monday Monday Morning Monday Afternoon Tuesday Tuesday Morning Tuesday Afternoon Wednesday Wednesday Morning Wednesday Afternoon Thursday Thursday Morning Thursday Afternoon Friday Friday Morning Friday Afternoon Primary reason for appointment: Dental Insurance: How did you hear about Dental Faculty Practice?