Request an Appointment

Whether its a toothache that ails you, time for your regular cleaning, in need of a Head Start checkup or find yourself requiring a consultation to discuss all the options available to whatever suits you, we offer a wide range of services to best serve you, our patients.

Please fill out the form below in its entirety so we may have a better understanding on how we can not only help you with any and all requests, but so we can also reach you when it comes time to finalize your appointment day and time. 


Name *
Phone *
Date of Birth *
Date of Birth
Requested Day of Appointment *
Please select the day(s) which would best suit you:
Dr Long's office does not currently accept any form of Kentucky Medicaid. We apologize for any inconvenience. *

*Please note that although we will try our hardest to work with your schedule, we cannot guarantee a specific day and time unless we confirm an open spot in our schedule.