Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office 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.

Gallagher Orthodontics

2800 William D. Tate, #100, Grapevine, Texas 76051

120 S. Denton Tap Road, #100, Coppell, Texas 75019

8825 Davis Blvd. #150, Keller, Texas 76248

817-562-2222

*Items in bold are required.

Name: Email: Phone:

Are you a current patient? Yes
No

How did you hear about us?

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

Grapevine 2800 William D. Tate
Coppell 120 S. Denton Tap Road #230
Keller 8825 Davis Blvd., #150

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

Any DayMondayTuesdayWednesdayThursdayFriday

Preferred time(s) for an appointment?

Any TimeMorningNoonAfternoon

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

Any DayMondayTuesdayWednesdayThursdayFriday

Preferred time(s) for an appointment?

Any TimeMorningNoonAfternoon

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.):

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

Gallagher Orthodontics

2800 William D. Tate, #100, Grapevine, Texas 76051

120 S. Denton Tap Road, #230, Coppell, Texas 75019

8825 Davis Blvd., #150, Keller, Texas 76248

817-562-2222

Testimonials

Excellent Orthodontist Office
Dr. Gallagher's office has been a very positive experience for us. His staff is professional, friendly and very customer-oriented. My daughter's teeth have benefited greatly. We highly recommend him and his staff.

Caitlin S.