Appointment RequestAppointment RequestThe dental office of Bast Dental Clinic is always happy to accept new patients! For your convenience you can request your appointment online. Please allow up to one full business day for one of our patient care coordinators to follow up with you to confirm your appointment.Please do NOT use this form to cancel or change your appointment. Please call our office at 907-479-2206."*" indicates required fieldsPatient InfoYour Name*Phone NumberYour Email* Are you a current patient of ours? Yes NoHow did you hear about us? Google Yellow Pages Facebook Referral OtherAppointmentDate Requested MM slash DD slash YYYY Would you like to request another date? Would you like to request another date?Date Requested #2 MM slash DD slash YYYY Briefly describe the reason for your appointment.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.