Appointment Request | Auburn, MA | Balian family Dental

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.

*Items in bold are required.

Name: Email: Phone:

Are you a current patient? Yes
No

How did you hear about us?

Which office location(s) would you prefer for your appointment?

Auburn 741 Southbridge Street
Sturbridge 419 Main Street

Preferred day(s) of the week for an appointment?

Any DayMondayTuesdayWednesdayThursdayFriday

Preferred time(s) for an appointment?

Any TimeMorningNoonAfternoon

Preferred day(s) of the week for an appointment?

Any DayMondayThursday

Preferred time(s) for an appointment?

Any TimeMorningNoonAfternoon

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

SpamBlocker

Do not fill this textbox.

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

Balian Family Dental

Sturbridge | 419 Main Street, Sturbridge, MA 01566 - (508) 217-9919

Auburn | 741 Southbridge Street, Auburn, MA 01501 - (508) 721-7720

ACCESSIBILITY