Dental Apppointment Request Form Please fill the items accurately
Active Duty ONLY
Fill in the fields in the form below and press submit.
Appointment should be booked within 3 workdays, contact SECJAX Sickbay if you have questions or concerns.
Dental exams will be scheduled as closely to the date/time requested. If the date/time requested can not be honored then first available appointment will be scheduled. Appointments typically are 2 weeks from today.