Lifetime Dental Care DMD PC - Make an Appointment

REQUEST AN APPOINTMENT ONLINE

Lifetime Dental Care
Michael D. Breier, D.M.D., P.C.
2469 Queensgate Dr.
Richland, WA 99352
(509) 628-1144 Phone

(509) 628-1161 Fax

Hours: Tuesday-Friday 8:00am to 5:00pm

To request an appointment with our office, simply complete and submit our online appointment form below. We will make every effort to accommodate your request. A member of our staff will contact you upon receiving your completed form.

Contact information:

Name:

Last

First

MI

Parent/guardian if patient is under 18

Address1:

Address 2:

City:

State:

E-mail:

Zip:

Dental Ins.:

Did someone refer you?

Yes

No

If yes, please provide name?

Preferred appointment day:

Home Phone

(

)

-

Work/Cell Phone

(

)

-

No preference. Schedule me for the earliest available appointment.

I prefer to be seen on the following day:

Have we seen you before?

Yes

No

If so, what date were you most recently treated?

Please briefly describe the nature of your treatment needs.