New York Dental and Oral Medicine Services - Appointment Request

The first step in working together on what is important to you 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.

As a full-time academic-clinician at New York University, Dr. Sirois' office hours are generally limited to Wednesdays only. However, although uncommon, on a case-by-case basis exceptions are possible.

And, Dr. Sirois will ALWAYS make time for emergent or urgent needs of patients in our care... so rest assured you are in good hands, and we are here for you when you need us! 

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


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.