Form

Appointment Request

Please use this form to request an appointment in our office via our secure portal. Appointment requests will be managed by our team during our regular business hours Monday through Thursday. You do not have a scheduled appointment until you receive confirmation from Bigfork Dental Center.

If you're experiencing a dental emergency or need urgent assistance, please call (406) 837-5611 and speak with an available team member or follow prompts from our after-hours voicemail system. Thank you!

First Name

Last Name

Phone #

Email Address

Comments: If you are requesting a consultation or have a dental emergency please specify your concern so we may appoint you properly.

Preferred time of appointment:

Preferred day of the appointment (select all appropriate)

Please tell us how you heard about us!

Date Of Birth

Do You Have Insurance?

Insurance Company

Insurance ID or Social Sec. #

Upload A Photo of Your Insurance Cards Below

Upload or drag files here