If you or your child are experiencing a dental emergency, please call 262-522-7645 for immediate assistance.
If it is after hours, please go to the nearest emergency room.

We’re here to help make dental care simple and accessible for your family. Community Smiles Dental does not accept commercial insurance plans and primarily serves patients with BadgerCare/ForwardHealth/Medicaid or those who are uninsured and meet income guidelines. Complete the form below to request an appointment, and a member of our team will contact you to confirm availability and next steps. If you’re unsure whether you qualify for care, please review our Am I Eligible? page before submitting your request. Community Smiles Dental does not accept commercial insurance plans.

Prefer to speak with someone directly? Call us at 262-522-7645 and our team will be happy to assist you.

Request an Appointment
Name
Name
First Name
Last Name
Is this appointment for a child?
Has the patient been seen at our clinic before?
We are not currently accepting new adult patients.
Please do not include medical or dental information in this form. A team member will contact you to confirm eligibility and availability.