Request Your Visit to Bencivengo & Ko, DMD

For the convenience of our patients, you can request an appointment to our office directly on our website! Once submitted, please wait until a member of our team reaches back out to you to officially schedule your appointment. The request is not a guarantee. Our staff will confirm the date and time for your appointment. You may also call the office at (860) 582-8095 to schedule an appointment!

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
Message
Describe the nature of your appointment or any other comments