Capitol Hill Dental Clinic
Dr. William Wong, Dr. Cindy Fong, Dr. Yi-Mun Leong
Creating Beautiful Smiles

Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone, e-mail or by filling out the forms below. Our scheduling coordinator will contact you to confirm your appointment.

To make an appointment for our EXISTING AND NEW PATIENTS, please fill out the following forms. These include:

   1)            Patient Pre - Screening Form

Please Note: At this time, WE WILL NOT BE ACCEPTING CASH.

   2)        New Patient Form 

Please Note: This form is for NEW PATIENTS ONLY

A team member will get back to you once the forms have been completed. We have to try with the best of our ability to determine what you need ahead of time before you come to the office. We will have to get as much information prior through photos, the information you provide us online and talking on the phone.

Please do not use this form to cancel or change an existing appointment, please contact the office by phone or e-mail. Our office requires 2 business days advance notice to cancel or change an appointment. Failure to show up for a scheduled appointment will result in a $75 administration fee.


*Items in bold are required.
Are you a current patient?

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.


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