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Appointment Request

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Appointment Request


The first step towards a beautiful, healthy smile is to reserve time for an evaluation. Please contact our office by phone or complete the Appointment Request Form below. Our scheduling coordinator will contact you concerning a reservation with Drs. Leslie Ferrara or Maria Upshaw.  

This form is NOT intended to change or cancel any existing reservations. Please do not use this form in attempts to make changes, as it will likely be routed incorrectly and could not receive the attention deserved or required. Fees upwards of $65 are applied when 48-business hours are not provided to cancel or change any existing reservations. 

Office Hours:

Monday - Thursday   8:00AM - 5:00PM

Friday - Sunday          CLOSED

***Hygiene Appointments may begin as early as 7:00AM on Tuesday & Thursday, by appointment only.


*Items in bold are required.
Are you a current patient?


Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Please Note: Messages sent using this form are NOT considered private. Please contact out office by telephone if highly confidential or private information must be provided. Messages should never include your social security or credit card numbers. 

We strive to meet the needs of the busy professional and every effort is made to be prompt for each of our patients. Each appointment made is reserving our doctors' or hygienists' time, JUST FOR YOU. With that in mind, it is imperative that you notify our office no less than 48 business hours, prior to your appointment, should you have any changes to your scheduled time with us. With less notice than this, we may not be able to offer the reservation to patients who have been waiting for a sooner appointment time. We ask for your cooperation in this matter to help all of our patients achieve the finest care we can provide. 

Cancellation/Reschedule fees assessed would be $65; although we hope you never have to incur said fee, we would like for all of our current and future patients to be aware of our policies, especially when involving a financial aspect. 

THIS POLICY IS PRIMARILY IN PLACE TO ENSURE VALUE TO EACH AND EVERY RESERVATION SCHEDULED. Thank you, in advance, for your understanding.

 

Smile With Confidence

As dental professionals it is our priority to provide quality dental care you can trust.

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