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Online Dental Appointment Request Form - General Dentist, Dr. Derek Fika

The first step towards a beautiful, healthy smile is to schedule a dental appointment. Now, you can schedule a dental appointment with Dr. Derek Fika Family Dentistry in Edmonton, AB easier than ever! Here, we provide you with the ease of scheduling a cosmetic procedure online.

Please contact our family and cosmetic dentistry office located in Edmonton 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 with Dr. Fika.


Office Hours

Monday 8am-4:30pm
Tuesday 8am-4:30pm
Wednesday 8am-4:30pm
Thursday 8am-3:00pm
Friday 8am-2:00pm

Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):
 
 

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