Request an Appointment

For your convenience , we will try to arrange your office visits for times that fit your schedule. For routine dental services, cleanings, or to set a time for a consultation for reconstructive or cosmetic dentistry, please use this form to request an appointment.

Note: If you have a dental emergency, please call 262-639-7000.

Please complete as much of form as possible, then click Request Appointment button at bottom of page.

Full Name:

Email Address:

Reason for Appointment:

What times and days of week are convenient to you?

Will this be your first visit to Dr. Westman?

Yes   No

Home Phone:

Work Phone:

Cell Phone:

How did you hear about our practice?

Use area below for referrals or other comments:

We check our email several times a day and will usually reply in 24 hours or less.