Appointment Request

Appointment Request Form 

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.


Patient Information

Patient Availability

Reason For Visit

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

San Jose Dentist, Dr. Jeff Sholer is a professional dedicated to Excellence in General, Family, & Cosmetic Dentistry such as Dental Makeovers, Porcelain Veneers, Teeth Whitening, Crowns/Caps & many other dental procedures. Please come and visit Dr. Jeff Sholer and Associates in San Jose.

2024 Jeffrey R. Sholer, DDS
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