Appointment Request Form

Please use our appointment request form to request an appointment with our office. This form is encrypted to insure the transmission of your information over the Internet is secure and to insure that our service meets and exceeds all governmental regulations regarding your right to privacy.

Is there a specific date that you would prefer?

What day of the week would you like to come in?

What approximate time do you prefer?

Which is more flexible for you?

Which doctor would you like to see, or is this request for hygiene?

Which office is more convenient for you?

Full Name:

Email Address:

What is the best number to contact you?

Please describe the nature of your appointment request:

Move the slider to the arrow and click Submit:

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27239 Wolf Road, Bay Village, OHIO 44140 | Phone: 440.892.1810

Dr. Louis Malcmacher is dedicated to excellence in cosmetic and restorative dentistry, specifically laser dentistry, one hour teeth whitening and porcelain veneers. Located in Bay Village, Ohio, the office serves patients throughout the Cuyahoga County area including neighboring cities such as:

Westlake, Avon, Avon Lake, N. Olmsted and Rocky River.