accessibility ACCESSIBILITY
The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.

 

 

 Forms to fill out before appointment:

  

New Patient Information.pdf

Medical History.pdf

Referral Brochure.pdf

Hours: Monday: 9-5pm   Tuesday: 9-1pm      Wednesday: 9-5pm      Thursday: CLOSED       Friday: 9-5pm   and   the second Saturday of each month.  We are closed daily: 1-2pm for lunch

 

*Due to a recent influx of no show appointments and last minute cancelations, Dr. Acone has instated a new "Appointment Reservation Fee" policy.  All patients wanting to schedule services for periodontal cleanings and/or other periodontal treatment, will be required to leave a credit card or post dated check on file to cover their reservation fee.  The assessed fee reserves your appointment time slot for your scheduled service on the specific date and time agreed upon. Once you arrive to your appointment you can either permit us to apply those funds to you existing treatment or have a portion credited, less any co-payment/deductible if it applies. If a patient needs to cancel or change their scheduled appointment and fails to contact (we must receive verbal communication by the patient) the office of Dr. Acone 72 hours prior to their scheduled appointment, your reservation fee will be processed on the date of their missed appointment. We are committed to providing the best care to our patients and we ask for your support  and commitment as well.  Thank You for your understanding and efforts.





 


Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
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.):
 
 

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.