Request an Appointment | Chemung Family Dental

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Request an Appointment

Fill out the form below and a member of our team will call you within one business day to find a time that works. Prefer to talk? Call (607) 734-2045.

First name*

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Last name*

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Email*

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Phone*

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Are you a new or existing patient?*

New patient Existing patient

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What brings you in?*

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Preferred times (optional – select any that work)

Weekday mornings (7 AM – noon) Weekday afternoons (noon – 4 PM) Any time – flexible

Best way to reach you?*

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SMS consent (required to text you): I consent to receive text messages from Chemung Family Dental for appointment reminders and confirmations. Msg & data rates may apply. Reply STOP to opt out.

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Optional: I’d also like to receive occasional marketing messages (review requests, promotional offers, feedback surveys). Reply STOP to opt out at any time.

Optional: Send me occasional oral health tips, practice news, and offers via email. Unsubscribe at any time.

Anything else we should know? (optional)

Please do not include sensitive medical or personal details in this form. For medical questions, call (607) 734-2045. See our Privacy Policy.

What happens next

1. You submit this form.

2. We call you within one business day.

3. We find an appointment time that works.

4. If you’re a new patient, we’ll send you the forms to fill out ahead of time.

Office hours

Mon-Wed: 7 AM – 4 PM
Thu: 7 AM – 2 PM
Fri-Sun: Closed

Emergency?

If you have a dental emergency, please call us at (607) 734-2045 instead of using this form.

Find us

Chemung Family Dental
1007 Broadway St
Elmira, NY 14904

The dentist who still knows your name

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Services

General Dentistry
Dental Implants
Sleep Apnea Treatment
Cosmetic Dentistry

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Contact

1007 Broadway St
Elmira, NY 14904
607-734-2045
info@chemungfamilydental.com

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