Contact Contact Us If you have any questions, concerns, or comments regarding our practice, please fill out the contact form below. Your name(Required) Your email address(Required) Phone(Required)Preferred Location(Required)Preferred LocationAkronCantonGreenDoylestownDoctor(Required)DoctorDr. Erick Chamblee, DDSDr. Matthew Jurcak, DDSDr. Tim Koehler, DMDDr. David Severson, DDSDr. Amar Vagadia, DDSDr. Jeremy Wanzer, DDSComments(Required)Consent Click hereI understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.CAPTCHA Request An Appointment Request An Appointment Request an appointment by filling out the form below and we will contact you as soon as we can.Your Name*(Required) Your email address*(Required) PhonePreferred Location*(Required)Preferred Location*AkronCantonGreenDoylestown