Confirm Appointment

To better serve our patients, we allow our patients to confirm a scheduled appointment with one of our providers by completing and sending this simple form below.

If for any reason you cannot keep your scheduled appointment, have a dental emergency, or require immediate attention, please call our office at (607) 797-5932.

We ask that you please call us at least 48 hours in advance to reschedule or cancel your appointment.

Name*

Appointment Date*

Appointment Time*

Email Address*

Phone Number 1*

Home Work Cell

Phone Number 2

Home Work Cell

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Confirm Appointment