Request Appointment

Use this form to schedule an appointment, request a free consultation or ask us a question regarding any procedure. Your contact information will be kept strictly confidential. Online appointment requests are handled weekdays during business hours.

If you need immediate attention please call our offices at 763-323-1492.



Name*
Phone*
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What method would you like us to use to contact you?
Phone
Email
If phone, what time would you prefer to be called?
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Preferred Day/Time


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Name*
Phone*
Email*
What method would you like us to use to contact you?
Phone
Email

If phone, what time would you prefer to be called?
Comments