Dr. Michael Thomas, DDS - Appointment Request

*Items in bold are required.

Name: Email: Phone:

Are you a current patient?

Yes

Which office location(s) would you prefer for your appointment?

Bullhead City 1093 Hancock Rd
Lake Havasu City 101 Riviera Dr

Preferred day(s) of the week for an appointment?

Any DayMondayTuesdayWednesdayThursdayFriday

Preferred time(s) for an appointment?

Any TimeMorningAfternoon

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.

REQUEST AN APPOINTMENT