Appointment Request
Please complete the online form below to request an appointment. We look forward to seeing you!
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Office Location:
Select A Location
Alton, IL - 3432 College Avenue
Belleville, IL - 1801 North Belt West Suite C
Belleville, IL - 5300 West Main
Bloomington, IL - 507 North Hershey Dr., Suite D
Bloomington, IL - 1507 N. Veterans Parkway
Champaign, IL - 14 East Anthony Dr., Suite B
Clearwater, FL - 13501 Icot Blvd., Suite 101
Columbia, IL - 242 Southwoods Centre Drive
East Alton, IL - 50 North Center Street
Gahanna, OH - 690 Morrison Road, Suite B
Indianapolis, IN - 3915 Madison Ave.
Litchfield, IL - 515 North Monroe
Peoria, IL - 3412 W. Willow Knolls Rd., Suite A
Springfield, IL - 2965 S. MacArthur Suite B
St. Charles, MO - 1600 Heritage Landing, Suite 210
Tampa, FL - 5200 N. Armenia Ave.
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First Name:
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Last Name:
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Phone #
(With Area Code)
:
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E-Mail Address:
Are you a new patient?
YES
NO
Preferred day of the week?
MON
TUE
WED
THU
FRI
ANY
Preferred time of day?
A.M.
P.M.
How did you find us?
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Required Fields
Affordable Dentistry Today, PC, Scott Ritchhart, DMD, O. Craig Shanteau, DDS, Samson Liu, DDS, Owners
