Appointments in Mankato, MN - Advanced Dental Mankato

Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!

Name*

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

If you are a new patient, when was your last dental cleaning and visit?

Insurance Name

ID Number

Preferred Date*

* Must select Monday - Friday

Preferred Time

Regular Hours:
Monday: 8:00am – 5:00pm
Tuesday: 8:00am – 5:00pm
Wednesday: 8:00am – 5:00pm
Thursday: 8:00am – 5:00pm
Friday: 7:00am – 2:30pm

Summer Hours:
Monday: 7:30am – 3:30pm
Tuesday: 7:30am – 3:30pm
Wednesday: 7:30am – 4:30pm
Thursday: 7:30am – 3:30pm
Friday: 7:30am – 1:00pm

Nature of Visit