Schedule an Appointment – Vicksburg Orthodontics

The first step toward enhancing your smile is to schedule an appointment with Vicksburg Orthodontics. Complete the appointment request form below, and our scheduling coordinator will contact you to confirm your appointment.

If you need to cancel or reschedule an existing appointment or if you require immediate assistance, call us directly at 601.661.0804.

Your Name:*
First Last
Your Contact Information
Mailing Address:*
Street Address City ZIP Code
Email Address:*
Phone Number:*
Patient's Information & Appointment Request
Name of Patient:*
First Last
New Patient?*
- YES
- NO
Gender:*
- Male
- Female
Age*
How did you hear about us?*
Other Referral*
Preferred Appointment Date*
MM
DD
YYYY
Preferred Appointment Time*

: HH

MM
Reason for Visit*
- Schedule a new orthodontic appointment
- Schedule a routine orthodontic appointment
- Schedule a comprehensive orthodontic appointment
- Other
Additional Appointment Request Information:
Email
This field is for validation purposes and should be left unchanged.

Business Hours

Monday and Wednesday, 8:00 am – 4:00 pm
Tuesday and Thursday, 8:00 am – 5:00 pm
Friday, 8:00 am – 12:00 pm

1909A Mission 66
Vicksburg, MS 39180

Your Contact Information

Patient's Information & Appointment Request

Business Hours

601.661.0804