Appointment Request - Schedule an Appointment with Belmont Dentistry

"If you are looking for a friendly, efficient, compassionate and knowledgeable dentist, Dr. Timothy Cooper is your man.

He was the first dentist that ever called me to see how I was doing after a procedure. I was very touched.

He brought to mind a procedure that no other dentist told me about and I have seen a dozen dentist, at least. The others always want to do the crown and he is the first one to suggest the onlay. I am very thrilled that I get to keep most of my tooth and not have yet another crown. So thank you Dr. Cooper for you kindness and insight." D.W., Scottsdale, AZ

"If you are looking for a friendly, efficient, compassionate and knowledgeable dentist, Dr. Timothy Cooper is your man. He was the first dentist that ever called me to see how I was doing after a procedure. I was very touched.

We understand that choosing a dentist can be a little scary or confusing. We'd like to make help make that choice a little easier by inviting you to check out our office with one of two special offers! Choose between:

1. No Risk, No Charge Exam and X-Rays or

2. Free Teeth Whitening with a paid exam, x-rays and cleaning!

To request your appointment, please fill out the form below. Our scheduling coordinator will contact you.

Is there a specific date that you would prefer?
Desired Year- Desired Month - Desired Day

Is there a specific time that you would prefer?
Desired Hour: Desired Minute Desired AM/PM

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

What time of day do you prefer?
Preferred Time of Day

Take advantage of our new patient special
Special

Full Name

Email Address

Phone Number

Please describe the nature of your appointment:
Comments

Patient Forms
Please print and fill out these forms so we can expedite your first visit:

Patient Registration
Health History Form

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

We retain the right to bill your insurance for any covered services. Offers not to be used in conjunction with any other offers or reduced fee plans. Limit 2 per household.