Daniel R. Tift, DDS

Creating Beautiful Smiles

Appointment Request

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.

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Patient Information

Name

Email

Phone

Are you a current patient?YesNo

How did you hear about us?

Patient Availability

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

Preferred time(s) for an appointment? Any TimeMorningNoonAfternoon

Reason For Visit

Please describe the nature of your appointment?

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

Ready to Get Started?

Quality professional team members that pride ourselves in furthering education to ensure you get the quality care you deserve.

Come See Us

302 East State StreetBelding, MI 48809Get Directions(616)794-2620

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