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76</head>
77<body class="page_request-an-appointment ">
78    <div id="fixed-tabs">
79        <a href="request-an-appointment.html" class="ra">
80          <span><i class="icon-calendar-1"></i><em>Request</em></span>
81          <span>Request<strong> Appointment</strong></span>
82      </a>
83        <a href="new-patients.html#forms" class="fm">
84          <span><i class="icon-doc-text"></i><em>Patient <br>Forms</em></span>
85          <span><strong>Download Our </strong>Forms</span>
86      </a>
87         <a href="https://www.facebook.com/Epic-Family-Dentistry-2249973401888920/?ref=br_rs" target="_blank" class="fb">
88          <span><i class="icon-facebook"></i><em>Like <br>Us</em></span>
89          <span>Like us<strong> on Facebook</strong></span>
90      </a>
91        <!--<a href="#" target="_blank" class="gp">
92          <span><i class="icon-gplus"></i><em>Read <br>Reviews</em></span>
93          <span><strong>Read Our </strong>Reviews</span>
94      </a> -->
95        <a href="tel:19728207294" class="call">
96          <span><i class="icon-phone"></i><em>Call</em></span>
97          <span><strong>Give us a </strong>Call</span>
98      </a>
99        <a href="https://www.google.com/maps/place/Epic+Family+Dentistry/@32.9539352,-96.8592118,17z/data=!3m1!4b1!4m5!3m4!1s0x0:0x50d2f2c4585c023a!8m2!3d32.9539352!4d-96.8570231?hl=en" target="_blank" class="map">
100          <span><i class="icon-location"></i><em>Map</em></span>
101          <span><strong>View our </strong>Map</span>
102      </a>
103    </div>
104    <header class="slideDown">
105        <!--<div class="covid">
106  <a href="covid-19-safety-protocol.html">Click Here to Learn More about our Advanced Safety Protocols</a>
107</div>-->
108        <div id="top-bar">
109            <div class="contain">
110                <div>
111                    <a href="preventive-dentistry.html#emergency">Same-Day Dental Emergencies</a> <em>•</em> <a href="se-habla-espanol.html">Se Habla Español</a> <em>•</em> <a href="new-patients.html#insurance">Dental Insurance &amp; Medicaid Welcome</a>
112                </div>
113            </div>
114        </div>
115        <div id="main-header">
116            <div class="contain place-nav">
117                <a class="logo" href="/"><img src="assets/images/logo-header-2.png" alt="Epic Family Dentistry of Carrollton logo"> </a>
118                <div class="header-contact">
119                    <div>
120                    <a class="tel" href="tel:19728207294"><i class="icon-phone"></i> (972) 820-7294</a>
121                    <address>
122                        <a href="https://www.google.com/maps/place/Epic+Family+Dentistry/@32.9539352,-96.8592118,17z/data=!3m1!4b1!4m5!3m4!1s0x0:0x50d2f2c4585c023a!8m2!3d32.9539352!4d-96.8570231?hl=en" target="_blank"><i class="icon-location"></i>2741 E. Belt Line Rd #101 Carrollton, TX 75006</a>
123                    </address>
124                    </div>
125                    <a href="request-an-appointment.html" class="header-btn"><strong>Request</strong> An Appointment</a>
126                </div>
127            </div>
128        </div>
129                        <nav>
130 
131                          <div id="mobile-header" class="mean-show">
132                            <div class="social">
133                                <a class="google-footer" href="https://www.google.com/search?ludocid=5823984193253409338&hl=en&q=Epic%20Family%20Dentistry%202741%20E%20Belt%20Line%20Road%20%23101%20Carrollton%2C%20TX%2075006&_ga=2.213770772.140072220.1541090546-1912211557.1530133454#fpstate=lie" target="_blank"><i class="icon-gplus"></i></a>
134                                <a class="face-footer" href="https://www.facebook.com/Epic-Family-Dentistry-2249973401888920/?ref=br_rs" target="_blank"><i class="icon-facebook"></i></a>
135                                <!--<a class="yelp-footer" href="#" target="_blank"><i class="icon-yelp"></i></a>-->
136                            </div>
137                          </div> 
138                          <ul id="regular-nav"><li><a href="/" title="Dentist Carrollton, TX">Home</a></li> <li><a href="about-us.html" title="About Us">About Us</a> <ul id="regular-nav"><li><a href="about-us.html" title="What Makes Us Different">What Makes Us Different</a></li> <li><a href="meet-our-dentists.html" title="Meet The Dentists">Meet Our Dentists</a> <ul id="regular-nav"><li><a href="dr-afshin-azmoodeh.html" title="Carrollton Dentist, Dr. Afshin Azmoodeh">Dr. Afshin Azmoodeh</a></li> <li><a href="dr-moses-shin.html" title="">Dr. Moses Shin</a></li> <li><a href="dr-mia-williams.html" title="Dr. Mia Williams">Dr. Mia Williams</a></li> </ul></li> <li><a href="meet-our-team.html" title="Meet Our Dental Team">Meet Our Team</a></li> <li><a href="covid-19-safety-protocol.html" title="Advanced Safety Protocol">COVID 19 Safety Protocol</a></li> <li><a href="https://www.epicfamilydentistry.com/blog/" title="Blog">Blog</a></li> </ul></li> <li><a href="our-services.html" title="Dental services">Our Services</a> <ul id="regular-nav"><li><a href="preventive-dentistry.html" title="Preventive Dentistry">Preventive Dentistry</a> <ul id="regular-nav"><li>
138<a href="periodontal-therapy.html" title="Gum Disease Treatment">Periodontal Therapy</a> </li> <li><a href="childrens-dentistry.html" title="Children’s Dentistry">Children’s Dentistry</a></li> <li><a href="checkups-cleanings.html" title="Dental Checkups">Checkups & Cleanings</a></li> </ul></li> <li><a href="restorative-dentistry.html" title="Restorative Dentistry">Restorative Dentistry</a> <ul id="regular-nav"><li><a href="dental-crowns.html" title="Dental Crowns">Dental Crowns</a></li> <li><a href="dental-bridges.html" title="Dental Bridges">Dental Bridges</a></li> <li><a href="full-and-partial-dentures.html" title="Full & Partial Dentures">Full & Partial Dentures</a></li> <li><a href="tooth-colored-fillings.html" title="Tooth-Colored Fillings">Tooth-Colored Fillings</a></li> <li><a href="root-canal-therapy.html" title="Root Canal Therapy">Root Canal Therapy</a></li> <li><a href="tooth-extractions.html" title="Tooth Extractions">Tooth Extractions</a></li> <li><a href="wisdom-tooth-extractions.html" title="Wisdom Tooth Extractions">Wisdom Tooth Extractions</a></li> </ul></li> <li><a href="dental-implants.html" title="Dental Implants">Dental Implants</a> <ul id="regular-nav"><li><a href="implant-retained-dentures.html" title="Dental Implant-Retained Dentures">Implant-Retained Dentures</a></li> </ul></li> <li><a href="cosmetic-dentistry.html" title="Cosmetic Dentistry">Cosmetic Dentistry</a> <ul id="regular-nav"><li><a href="teeth-whitening.html" title="Teeth Whitening">Teeth Whitening</a></li> <li><a href="dental-bonding.html" title="Dental Bonding">Dental Bonding</a></li> <li><a href="orthodontic-solutions.html" title="Invisalign">Orthodontic Solutions</a> <ul id="regular-nav"><li><a href="sure-smile-aligners.html" title="SureSmile">Sure Smile Aligners</a></li> </ul></li> <li><a href="porcelain-veneers.html" title="Porcelain Veneers">Porcelain Veneers</a></li> </ul></li> <li><a href="advanced-services-technology.html" title="Advanced Dental Services & Technology">Advanced Services & Technology</a> <ul id="regular-nav"><li><a href="tmj-treatment.html" title="TMJ Treatment">TMJ Treatment</a></li> <li><a href="sedation-dentistry.html" title="Sedation Dentistry">Sedation Dentistry</a></li> </ul></li> <li><a href="emergency-dentistry.html" title="Emergency Dentist">Emergency Dentistry</a></li> </ul></li> <li><a href="new-patients.html" title="New Patients">New Patients</a> <ul id="regular-nav"><li><a href="new-patients.html" title="New Patient Info">New Patient Info</a></li> <li><a href="dental-insurance.html" title="Dental Insurance">Dental Insurance</a> <ul id="regular-nav"><li><a href="medicaid-and-chip-dentist.html" title="">Medicaid and CHIP Dentist</a></li> <li><a href="delta-dental-dentist.html" title="Delta Dental Dentist">Delta Dental Dentist</a></li> <li><a href="bluecross-blueshield-dentist.html" title="BlueCross BlueShield Dentist">BlueCross BlueShield Dentist</a></li> <li><a href="cigna-dentist.html" title="Cigna Dentist">Cigna Dentist</a></li> <li><a href="metlife-dentist.html" title="MetLife Dental Insurance">MetLife Dentist</a></li> <li><a href="aetna-dentist.html" title="Aetna Insurance">Aetna Dentist</a></li> <li><a href="unitedhealthcare-dentist.html" title="UnitedHealthcare Dentist">UnitedHealthcare Dentist</a></li> </ul></li> <li><a href="membership-plan.html" title="">Membership Plan</a></li> <li><a href="faqs.html" title="Dental FAQ">FAQs</a></li> <li><a href="specials.html" title="Specials">Specials</a> </li> </ul></li> <li><a href="reviews.html" title="Reviews">Reviews</a></li> <li><a href="contact-us.html" title="Contact Us">Contact Us</a> <ul id="regular-nav"><li><a href="dentist-near-farmers-branch.html" title="Dentist Near Farmers Branch, TX">Dentist Near Farmers Branch</a></li> <li><a href="dentist-near-addison-tx.html" title="Dentist Near Addison, TX">Dentist Near Addison, TX</a></li> <li><a href="contact-us.html" title="Office Info">Office Info</a></li> <li><a href="dentist-open-on-saturdays.html" title="">Dentist Open on Saturdays</a></li> <li><a href="carrollton-dentist.html" title="Carrollton, TX Dentist">Carrollton Dentist</a></li> <li><a href="request-an-appointment.html" title="Request an Appointment">Request an Appointment</a></li> <li><a href="se-habla-espanol.html" title="Se Habla Español">Se Habla Español</a></li> </ul></li> </ul>
139                    <div id="mobile-footer" class="mean-show">
140                      <span class="title">Office Hours</span>
141                      <p class="hours">
142                          <label>Monday:</label> 9:00am - 6:00pm
143                          <br>
144                          <label>Tuesday:</label> 9:00am - 6:00pm
145                          <br>
146                          <label>Wednesday:</label> 9:00am - 6:00pm
147                          <br>
148                          <label>Thursday:</label> 9:00am - 6:00pm
149                          <br>
150                          <label>Friday:</label> 9:00am - 6:00pm
151                          <br>
152                          <label>Saturday:</label> 9:00am - 2:00pm
153                           <br>
154                          <label>Sunday:</label> Closed
155                      </p>
156                    </div>
157                </nav>
158    </header>
159    <main>
160  <h1>
161	Request an Appointment</h1>
162<p>
163	Whatever dental needs you or your child might have, the team at Epic Family Dentistry of Carrollton is ready to meet them! To request an appointment, please take a few moments to fill out the short form below. After you have completed and sent the form, a member of our team will c
163ontact you shortly to help you schedule a time for your visit. With that, you&rsquo;ll be all set to come see us! Please let us know if you have any questions ahead of your first appointment.</p>
164<form action="assets/php/validator.php" class="styled-form" method="post">
165  <div class="drei">
166    <span class="input-content">
167          <input class="input__field" name="Name" type="text" required="true"/>
168          <label class="input__label"><span class="input__label-content">Full Name <strong>John Smith</strong></span></label>
169    </span>
170    <span class="input-content">
171          <input class="input__field" name="Phone" type="text" required="true"/>
172          <label class="input__label"><span class="input__label-content">Phone Number <strong>(555) 555-5555</strong></span></label>
173    </span>
174    <span class="input-content">
175          <input class="input__field" name="Email" type="email" required="true"/>
176          <label class="input__label"><span class="input__label-content">Email Address <strong>[email protected]</strong></span></label>
177    </span>
178  </div>
179  <div class="drei">
180    <div class="inline">
181      <label>Are you...</label>
182      <span><input name="PatientType[]" type="checkbox" value="New" /> A New Patient </span>
183      <span><input name="PatientType[]" type="checkbox" value="Existing" /> An Existing Patient </span>
184    </div>
185    <div class="inline">
186      <label>Preferred day of the week</label>
187      <span><input name="day[]" type="checkbox" value="Monday" /> Monday </span>
188      <span><input name="day[]" type="checkbox" value="Tuesday" /> Tuesday </span>
189      <span><input name="day[]" type="checkbox" value="Wednesday" /> Wednesday </span>
190      <span><input name="day[]" type="checkbox" value="Thursday" /> Thursday </span>
191      <span><input name="day[]" type="checkbox" value="Friday" /> Friday </span>
192      <span><input name="day[]" type="checkbox" value="Saturday" /> Saturday </span>
193    </div>
194    <div class="inline">
195      <label>Preferred time of the day</label>
196      <span><input name="time[]" type="checkbox" value="Morning" /> Morning </span>
197      <span><input name="time[]" type="checkbox" value="Afternoon" /> Afternoon </span>
198    </div>
199  </div>
200  <div class="hear">
201    <label>How did you hear about us?</label>
202    <select name="Discover">
203      <option value="">Select One</option>
204      <option>Search Engine</option>
205      <option>Family/Friend</option>
206      <option>Promotion</option>
207      <option>Social Media</option>
208      <option>Other</option>
209    </select>
210  </div>
211 
212  <!--<button class="btn">Submit Request</button>-->
213<input type="submit" name="submit" value="Submit Request" class="btn">
214  <input name="_subject" type="hidden" value="Request an Appointment" />
215  <input name="_redirect" type="hidden" value="thanks.html" />
216<input type="hidden" name="token_generate" id="token_generate">
217</form>
218    </main>
219    <div class="more-to-explore-container">
220    </div>
221    <footer>
222        <div id="footer-top">
223            <div class="contain">
224                <section id="footer-contact">
225                    <a class="logo" href="/">
226            <img src="assets/images/logo-footer-1.png" alt="Epic Family Dentistry of Carrollton logo">
227          </a>
228                    <a class="tel" href="tel:19728207294">(972) 820-7294</a>
229                    <address>
230                        <a href="https://www.google.com/maps/place/Epic+Family+Dentistry/@32.9539352,-96.8592118,17z/data=!3m1!4b1!4m5!3m4!1s0x0:0x50d2f2c4585c023a!8m2!3d32.9539352!4d-96.8570231?hl=en" target="_blank">2741 E. Belt Line Rd #101 <br> Carrollton, TX 75006</a>
231                    </address>
232                    <p class="hours">
233                        <label>Monday:</label> 9:00am - 6:00pm
234                        <br>
235                        <label>Tuesday:</label> 9:00am - 6:00pm
236                        <br>
237                        <label>Wednesday:</label> 9:00am - 6:00pm
238                        <br>
239                        <label>Thursday:</label> 9:00am - 6:00pm
240                        <br>
241                        <label>Friday:</label> 9:00am - 6:00pm
242                        <br>
243                        <label>Saturday:</label> 9:00am - 2:00pm
244                        <br>
245                          <label>Sunday:</label> Closed
246                    </p>
247                     <div class="social">
248                        <a class="google-footer" href="https://www.google.com/search?ludocid=5823984193253409338&hl=en&q=Epic%20Family%20Dentistry%202741%20E%20Belt%20Line%20
248Road%20%23101%20Carrollton%2C%20TX%2075006&_ga=2.213770772.140072220.1541090546-1912211557.1530133454#fpstate=lie" target="_blank"><i class="icon-gplus"></i></a>
249                        <a class="face-footer" href="https://www.facebook.com/Epic-Family-Dentistry-2249973401888920/?ref=br_rs" target="_blank"><i class="icon-facebook"></i></a>
250                          <a class="insta-footer" href="https://www.instagram.com/epicfamilydentistry/" target="_blank"><i class="icon-instagramm"></i></a>
251                        <!--<a class="yelp-footer" href="#" target="_blank"><i class="icon-yelp"></i></a>-->
252                    </div>
253                </section>
254                <section id="footer-form">
255                    <span class="title">Have Questions? Get Answers</span>
256                    <form method="post" action="assets/php/validator.php" class="forms">
257                        <input name="name" required placeholder="Name" type="text">
258                        <input name="phone" required placeholder="Phone Number" type="text">
259                        <input name="email" required placeholder="Email Address" type="email">
260                        <textarea name="message" placeholder="How can we help you?"></textarea>
261                       
262                        <input type="hidden" name="_subject" value="Footer Form">
263                        <input type="hidden" name="_redirect" value="thanks.html">
264                        <!--<button class="btn">Submit My Questions</button>-->
265                        <input type="submit" name="submit" value="Submit My Questions" class="btn">
266                        <input type="hidden" name="token_generate" id="token_generate">
267                    </form>
268                </section>
269            </div>
270        </div>
271        <section id="footer-services">
272            <div class="contain">
273                <span class="title">Featured Dental Services</span>
274                <ul>
275                  <li><a href="preventive-dentistry.html">Preventive Dentistry</a></li>
276                  <li><a href="preventive-dentistry.html#cleanings">Checkups & Cleanings</a></li>
277                  <li><a href="periodontal-therapy.html">Periodontal Therapy</a></li>
278                  <li><a href="childrens-dentistry.html">Children's Dentistry</a></li>
279                  <li><a href="restorative-dentistry.html">Restorative Dentistry</a></li>
280                  <li><a href="restorative-dentistry.html#crowns">Crowns & Bridges</a></li>
281                  <li><a href="full-and-partial-dentures.html">Dentures & Partials</a></li>
282                  <li><a href="restorative-dentistry.html#root">Root Canals</a></li>
283                  <li><a href="dental-implants.html">Dental Implants</a></li>
284                  <li><a href="cosmetic-dentistry.html">Cosmetic Dentistry</a></li>
285                  <li><a href="cosmetic-dentistry.html#veneers">Porcelain Veneers</a></li>
286                  <li><a href="cosmetic-dentistry.html#whitening">Teeth Whitening</a></li>
287                  <li><a href="cosmetic-dentistry.html#metalfree">All-Ceramic Restorations</a></li>
288                  <li><a href="orthodontic-solutions.html">Invisalign Clear Braces</a></li>
289                  <li><a href="sedation-dentistry.html">Sedation Dentistry</a></li>
290                  <li><a href="preventive-dentistry.html#emergency">Emergency Dentistry</a></li>
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