Request an Appointment

The first step toward achieving a beautiful, healthy smile is to schedule an appointment. To schedule an appointment, please complete and submit the request form below.

For patients transferring in from other orthodontic offices and for treatment related to TMD and facial pain issues the free smile exam does not apply. Initial exam fees will apply for transfers and for TMD cases.

Please note this form is for requesting an appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly.

Patient Name*
First Last
New Patient?*
- Yes
- No
Parent Name
First Last
Mobile Phone*
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type of Appointment
Preferred Location
Preferred Days
Preferred Times
How Did You Hear About Our Practice?
Comments

Virginia Beach

Chesapeake

Request an Appointment

Roy Orthodontics Locations

Virginia Beach Location

Chesapeake Location