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86    </head>
87    <body class="page_request-an-appointment ">
88        <header>
89            <div class="skip-link">
90                <a href='#main' id="main-link">Skip to Main Content</a>
91            </div>
92            <div id="hd-top">
93                <div class="hd-info">
94                    <a href="tel:+19722453395" class="pho">(972) 245-3395</a>
95                    <a href="https://www.google.com/maps/place/DD+Family+Dentistry+of+Carrolton/@33.0256832,-96.8897147,17z/data=!3m1!4b1!4m5!3m4!1s0x864c25f2f9acd24d:0x3b011c97bc7eb4e5!8m2!3d33.0256832!4d-96.887526?hl=en-US" class="phy" target="_blank">
96                    4221 Medical Pkwy Bldg. 2, #200, Carrollton, TX 75010
97                </a>
98                </div>
99                <div class="gcse-search"></div>
100                <div class="hd-btns">
101                    <a href="https://pay.vynetrellis.com/p/k8w84uga" target="_blank" class="btn of">Pay Online</a>
102                    <a href="request-an-appointment.html" class="btn ra">Request an Appointment</a>
103                </div>
104            </div>
105            <div id="hd-contents" class="place-nav">
106                <a class="logo" href="/" aria-label="home page">
107                    <img alt="DD Family Dentistry of Carrollton logo" src="assets/images/dd-family-logo-big.png" class="normal-logo">
108                    <img alt="DD Family Dentistry of Carrollton logo" src="assets/images/dd-family-logo-blue.png" class="slide-logo" style="display:none;">
109                </a>
110                <nav id="main-nav" tabindex="-1">
111                    <div class="nav-info">
112                        <a href="tel:+19722453395" class="pho">(972) 245-3395</a>
113                        <a href="https://www.google.com/maps/place/DD+Family+Dentistry+of+Carrolton/@33.0256832,-96.8897147,17z/data=!3m1!4b1!4m5!3m4!1s0x864c25f2f9acd24d:0x3b011c97bc7eb4e5!8m2!3d33.0256832!4d-96.887526?hl=en-US" class="phy" target="_blank">
114                            4221 Medical Pkwy Bldg. 2, #200, Carrollton, TX 75010
115                        </a>
116                        <div class="hd-btns">
117                            <!--<a href="https://pay.balancecollect.com/m/ddfamilydentistry" target="_blank" class="btn-alt of">Pay Online</a>-->
118                            <a href="request-an-appointment.html" class="btn-alt ra">Request an Appointment</a>
119                        </div>
120                    </div>
121                    
122                    <ul>
123                        
124                        <li><a href="/"
125                            title="Dentist Carrollton, TX">Home</a>
126                        </li> 
127                        <li><a href="about-us.html"
128                            title="About Us">About Us</a>
129                        
130                    <ul>
131                        
132                        <li><a href="about-us.html"
133                            title="What Sets Us Apart">What Sets Us Apart</a>
134                        </li> 
135                        <li><a href="meet-the-dentists.html"
136                            title="Meet the Dentists">Meet the Dentists</a>
137                        
138                    <ul>
139                        
140                        <li><a href="meet-dr-durga-devarakonda.html"
141                            title="Meet Dr. Durga Devarakonda">Meet Dr. Durga Devarakonda</a>
142                        </li> 
143                        <li><a href="meet-dr-holland-morrison.html"
144                            title="Meet Dr. Holland Morrison">Meet Dr. Holland  Morrison</a>
145                        </li> 
146                    </ul>
147                    </li> 
148                        <li><a href="meet-the-team.html"
149                            title="Meet the Dental Team">Meet the Team</a>
150                        </li> 
151                        <li><a href="tour-our-office.html"
152                            title="Tour Our Dental Office">Tour Our Office</a>
153                        </li> 
154                        <li><a href="https://www.ddfamilydentistrytx.com/blog/"
155                            title="Blog">Blog</a>
156                        </li> 
157                    </ul>
158                    </li> 
159                        <li><a href="our-services.html"
160                            title="Dental Services">Our Services</a>
161                        
162                    <ul>
163                        
164                        <li><a href="preventive-dentistry.html"
165                            title="Preventive Dentistry">I Need a Dental Checkup or Cleaning</a>
166                        
167                    <ul>
168                        
169                        <li><a href="checkups-and-cleanings.html"
170                            title="Dental Checkups and Cleanings">Dental Check-Ups & Cleanings</a>
171                        </li> 
172                        <li><a href="dental-sealants.html"
173                            title="Dental Sealants">Dental Sealants</a>
174                        </li> 
175                        <li><a href="nightguards.html"
176                            title="Nightguards">Nightguards</a>
177                        </li> 
178                        <li><a href="fluoride-treatments.html"
179                            title="Fluoride Treatments">Fluoride Treatments</a>
180                        </li> 
181                        <li><a href="gum-disease-treatment.html"
182                            title="Gum Disease Treatment">Gum Disease Treatment</a>
183                        </li> 
184                        <li><a href="childrens-dentistry.html"
185                            title="">Children’s Dentistry</a>
186                        
187                    <ul>
188                        
189                        <li><a href="lip--tongue-tie-treatment-frenectomies.html"
190                            title="Lip & Tongue-Tie Treatment">Lip & Tongue-Tie Treatment (Frenectomies)</a>
191                        </li> 
192                    </ul>
193                    </li> 
194                    </ul>
195                    </li> 
196                        <li><a href="special-needs-dentistry.html"
197                            title="Special Needs Dentistry">I’m Looking for a Special Needs Dentist</a>
198                        </li> 
199                        <li><a href="restorative-dentistry.html"
200                            title="Restorative Dentistry">I Have a Cavity or Broken Tooth</a>
201                        
202                    <ul>
203                        
204                        <li><a href="dental-crowns.html"
205                            title="Dental Crowns">Dental Crowns</a>
206                        </li> 
207                        <li><a href="tooth-colored-fillings.html"
208                            title="Tooth-Colored Fillings">Tooth-Colored Fillings</a>
209                        </li> 
210                    </ul>
211                    </li> 
212                        <li><a href="missing-teeth.html"
213                            title="Replace Missing Teeth">I’m Missing One or More Teeth</a>
214                        
215                    <ul>
216                        
217                        <li><a href="dental-bridges.html"
218                            title="Dental Bridges">Dental Bridges</a>
219                        </li> 
220                        <li><a href="dental-implants.html"
221                            title="Dental Implants">Dental Implants</a>
222                        
223                    <ul>
224                        
225                        <li><a href="all-on-4-dental-implants.html"
226                            title="All-On-4">All-on-4 Dental Implants</a>
227                        </li> 
228                        <li><a href="implant-dentures.html"
229                            title="Implant Dentures">Implant Dentures</a>
230                        </li> 
231                        <li><a href="dental-implant-failure-and-salvage.html"
232                            title="Dental Implant Failure and Salvage">Dental Implant Failure and Salvage</a>
233                        </li> 
234                    </ul>
235                    </li> 
236                        <li><a href="full-partial-dentures.html"
237                            title="Dentures">
237Full & Partial Dentures</a>
238                        </li> 
239                    </ul>
240                    </li> 
241                        <li><a href="cosmetic-dentistry.html"
242                            title="Cosmetic Dentist">Cosmetic Dentistry</a>
243                        
244                    <ul>
245                        
246                        <li><a href="veneers.html"
247                            title="Veneers">Veneers</a>
248                        </li> 
249                        <li><a href="cosmetic-dental-bonding.html"
250                            title="Cosmetic Dental Bonding">Cosmetic Dental Bonding</a>
251                        </li> 
252                        <li><a href="invisalign-clear-aligners.html"
253                            title="Invisalign® Clear Aligners">Invisalign® Clear Aligners</a>
254                        </li> 
255                        <li><a href="zoom-teeth-whitening.html"
256                            title="Teeth Whitening">Zoom! Teeth Whitening</a>
257                        </li> 
258                        <li><a href="gum-recontouring.html"
259                            title="gum recontouring">Gum Recontouring</a>
260                        </li> 
261                    </ul>
262                    </li> 
263                        <li><a href="sedation-dentistry.html"
264                            title="Sedation Dentist">Sedation Dentistry</a>
265                        </li> 
266                        <li><a href="emergency-dentistry.html"
267                            title="Emergency Dentist">Emergency Dentistry</a>
268                        
269                    <ul>
270                        
271                        <li><a href="tooth-extractions.html"
272                            title="Tooth Extraction">Tooth Extractions</a>
273                        </li> 
274                        <li><a href="wisdom-tooth-extractions.html"
275                            title="Wisdom Tooth Extractions">Wisdom Tooth Extractions</a>
276                        </li> 
277                        <li><a href="root-canal-therapy.html"
278                            title="Root Canal Treatment">Root Canal Therapy</a>
279                        </li> 
280                    </ul>
281                    </li> 
282                    </ul>
283                    </li> 
284                        <li><a href="for-patients.html"
285                            title="New Dental Patient Information">For Patients</a>
286                        
287                    <ul>
288                        
289                        <li><a href="for-patients.html"
290                            title="Your First Visit">Your First Visit</a>
291                        </li> 
292                        <li><a href="dental-insurance.html"
293                            title="Dental Insurance">Dental Insurance</a>
294                        
295                    <ul>
296                        
297                        <li><a href="bluecross-blueshield-bcbs-dentist.html"
298                            title="BlueCross BlueShield (BCBS) Dentist">BlueCross BlueShield (BCBS) Dentist</a>
299                        </li> 
300                        <li><a href="aetna-dentist.html"
301                            title="Aetna Dentist">Aetna Dentist</a>
302                        </li> 
303                        <li><a href="guardian-dentist.html"
304                            title="Guardian Dentist">Guardian Dentist</a>
305                        </li> 
306                    </ul>
307                    </li> 
308                        <li><a href="dental-savings-plan.html"
309                            title="Dental Savings Plan">Dental Savings Plan</a>
310                        </li> 
311                        <li><a href="new-patient-specials.html"
312                            title="New Patient Special Offers">New Patient Specials</a>
313                        </li> 
314                        <li><a href="faqs.html"
315                            title="Frequently Asked Dental Questions">FAQs</a>
316                        </li> 
317                    </ul>
318                    </li> 
319                        <li><a href="reviews.html"
320                            title="Dental Patient Reviews">Reviews</a>
321                        </li> 
322                        <li><a href="contact-us.html"
323                            title="Contact Us">Contact Us</a>
324                        
325                    <ul>
326                        
327                        <li><a href="contact-us.html"
328                            title="Office Info">Office Info</a>
329                        </li> 
330                        <li><a href="request-an-appointment.html"
331                            title="Request an Appointment">Request an Appointment</a>
332                        </li> 
333                        <li><a href="dentist-open-on-saturday.html"
334                            title="Dentist Open on Saturday">Dentist Open on Saturday</a>
335                        </li> 
336                    </ul>
337                    </li> 
338                    </ul>
339                    
340                </nav>
341            </div>
342        </header>
343        <main class="clearfix" role="main" id="main" tabindex="-1">
344            <section class="internal clearfix">
345                <div id="interior-banner" class="random">
346                    <div class="contain">
347                        <div id="page-title"></div>
348                    </div>
349                </div>
350                <div id="page">
351                    <h1>
352	Request an Appointment Carrollton</h1>
353<h2 id="append">
354	Quick, Easy Scheduling</h2>
355<div id="static-banner">
356	<img alt="Circling date on a virtual calendar" src="assets/images/request-appointment-1.jpg" /></div>
357<p>
358	At DD Family Dentistry of Carrollton, we know you have a busy schedule, and trying to <a href="contact-us.html">call </a>to plan a dentist&rsquo;s appointment for you and your family can be challenging. This is why you will find our easy-to-fill-out form below. Here, you can let us know what day is most convenient for you so that when we call, we can quickly get you scheduled to come to our Carrollton office and see us.</p>
359<form action="assets/php/validator.php" method="post" class="styled-form recaptcha-form">
360    <div class="drei">
361        <span class="input-content">
362        <input class="input__field" name="Name" type="text" required="true">
363        <label class="input__label"><span class="input__label-content">Full Name </span></label>
364        </span>
365        <span class="input-content">
366        <input class="input__field phone-input" name="Phone" type="text" pattern="(.){10,}"  required title="10 characters minimum" required="true">
367        <label class="input__label"><span class="input__label-content">Phone Number </span></label>
368        </span>
369        <span class="input-content">
370        <input class="input__field" name="Email" type="email" required="true">
371        <label class="input__label"><span class="input__label-content">Email Address</span></label>
372        </span>
373    </div>
374    <div class="drei">
375        <div class="inline options">
376            <label>Are you...</label>
377            <span><input name="PatientType[]" type="radio" value="New" required="required">A New Patient</span>
378            <span><input name="PatientType[]" type="radio" value="Existing" required="required">An Existing Patient</span>
379        </div>
380        <div class="inline options day">
381            <label>Preferred day of the week</label>
382            <span><input name="day[]" type="checkbox" value="Monday">Monday</span>
383            <span><input name="day[]" type="checkbox" value="Tuesday">Tuesday</span>
384            <span><input name="day[]" type="checkbox" value="Wednesday">Wednesday</span>
385            <span><input name="day[]" type="checkbox" value="Thursday">Thursday</span>
386            <span><input name="day[]" type="checkbox" value="Saturday">Saturday</span>
387        </div>
388        <div class="inline options comm">
389            <label>Preferred method of communication</label>
390            <span><input name="communication[]" type="checkbox" value="phone">Phone</span>
391            <span><input name="communication[]" type="checkbox" value="Text">Text</span>
392            <span><input name="communication[]" type="checkbox" value="email">Email</span>
393        </div>
394    </div>
395    <div class="drei">
396        <div class="inline options">
397            <label>How did you hear about us?</label>
398            <span><input name="hear[]" type="checkbox" value="Search Engine">Search Engine</span>
399            <span><input name="hear[]" type="checkbox" value="Family/Friend">Family/Friend</span>
400            <span><input name="hear[]" type="checkbox" value="Promotion">Promotion</span>
401            <span><input name="hear[]" type="checkbox" value="Social Media">Social Media</span>
402            <span><input name="hear[]" type="checkbox" value="Other"> Othe</span>
403        </div>
404        <div class="inline">
405            <label>What are you interested in?</label>
406            <textarea name="Interests" aria-label="Interests" placeholder="I am interested in…" required="true"></textarea>
407        </div>
408        <div class="inline">
409            <label>Questions or comments?</label>
410            <textarea name="Questions/Comments" aria-label="Questions" placeholder="Type your questions or comments here."></textarea>
411        </div>
412    </div>
413    <input type="submit" class="btn" value="Submit Request">
414    <input type="hidden" name="token_generate" id="token_generate">
415    <input name="_subject" type="hidden" value="Request Appointment">
416    <input name="_redirect" type="hidden" value="thanks.html">
417</form>
418                </div>
419                <!-- end of page -->
420            </section>
421            <!-- end of internal -->
422            <div class="full-page">
423                
424            </div>
425            <!-- end full page -->
426        </main>
427        <footer>
428            <div id="fo-contents">
429                <div class="fo-contain">
430                    <div class="fo-info">
431                        <a href="tel:19722453395" class="pho">(972) 245-3395</a>
432                        <a href="https://www.google.com/maps/place/DD+Family+Dentistry+of+Carrolton/@33.0256832,-96.8897147,17z/data=!3m1!4b1!4m5!3m4!1s0x864c25f2f9acd24d:0x3b011c97bc7eb4e5!8m2!3d33.0256832!4d-96.887526?hl=en-US" class="phy" target="_blank">
433                            4221 Medical Pkwy Bldg. 2, #200<br>
434                            Carrollton, TX 75010
435                        </a>
436                    </div>
437                    <div class="social">
438                        <a href="https://www.facebook.com/DDFamilyDentistryCarrollton/" class="fb" aria-label="facebook" target="_blank"><i class="icon-facebook"></i></a>
439                        <a href="https://www.google.com/maps/place/DD+Family+Dentistry+of+Carrolton/@33.0256832,-96.8897147,17z/data=!3m1!4b1!4m5!3m4!1s0x864c25f2f9acd24d:0x3b011c97bc7eb4e5!8m2!3d33.0256832!4d-96.887526?hl=en-US" class="gp" aria-label="google" target="_blank"><i class="icon-google"></i></a>
440                        <!-- <a href="" class="in" aria-label="instagram" target="_blank"><i class="icon-instagramm"></i></a> -->
441                    </div>
442                </div>
443                <a href="/" class="logo"><img src="assets/images/dd-family-logo-big.png" style="max-width:180px;"
444                    alt="DD Family Dentistry of Carrollton logo"></a>
445                <div class="hours">
446                    <p>
447                        <label>Monday</label>9:00 am - 6:00 pm<br>
448                        <label>Tuesday</label>9:00 am - 6:00 pm<br>
449                        <label>Wednesday</label>9:00 am - 6:00 pm<br>
450                        <label>Thursday</label>9:00 am - 6:00 pm<br>
451                        <label>Friday</label>Closed <br>
452                        <label>Saturday*</label>9:00 am - 1:00 pm<br>
453                        *Every Other Saturday
454                    </p>
455                </div>
456            </div>
457            <div id="copy">
458                <span classs="copy-row">&copy; <span id="copyDate"></span> DD Family Dentistry of Carrolton <span class="fo-line">|</span></span>
459                <span class="copy-row"><a href="sitemap.html">Sitemap</a><span class="fo-line">|</span><a href="privacy-policy.html">Privacy Policy</a><span class="fo-line">|</span></span>
460                <a href="https://www.tntdental.com" target="_blank" class="tnt">Site designed and maintained by <i class="icon-tnt"></i></a>
461            </div>
462        </footer>
463        <!-- Mobile Tabs -->
464        <ul id="fixed-tabs">
465            <li class="ra">
466                <a href="request-an-appointment.html">
467                    <span><i class="icon-calendar-1"></i> </span>
468                    <span>Request<strong> an Appointment</strong></span>
469                </a>
470            </li>
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