Dentist Douglaville Appointment Request

Need an appointment with a dentist in Douglasville? Requesting an appointment at our Douglasville, GA family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with Dr. J. Keith Smith today!


We accept all major credit cards, with the exception of American Express.

We also accept cash, check, and Care Credit (12 month interest free financing available).


Many major insurance plans are accepted; please call to verify if our office participates in your current plan. 

Patient Information (* denotes fields that are required)
Patient Name*
Phone Number*
Email Address
Are you a current patient?
No Yes
Best time(s) to call?
Morning Noon Afternoon Evening
Appointment Information
Preferred Appt Date
Preferred Appt Time
Describe the nature of your appointment or any other comments