Appointment Request Form

To request an appointment with Dr. Steven Chase and Dr. Jacqueline Kotula at Marin Dental Care in San Rafael please fill out our appointment request form located below. This will let us know what day and time works best for you. One of our team members will get in touch with you to confirm your appointment. Alternatively, you may also schedule an appointment by calling our office at (415) 499-7700.

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Please do not send personal health information through the form, specific patient care-related questions must be addressed with your doctor during an appointment.