Make an Appointment

At Glacier Grins we strive to make your children’s dental health a worry-free experience. Offering convenient appointment times and a personal approach, Dr. Chad wants you to feel at home.

Your Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Work Phone
Home Phone
Patient Information
Patient Name*
Age*
Gender:*
- Male
- Female
Appointment Information
Preferred Appointment Date*
Date Format: MM slash DD slash YYYY
Choose a Time*
- Morning
- Afternoon
Reason for Appointment*
Comments
Email
This field is for validation purposes and should be left unchanged.

Your Information

Patient Information

Appointment Information

Like Us On Facebook

Appointments

Our Location