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!   (* - required fields)

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

Name:  * Best time(s) to call?
Address:  
City:  
State/Province:  
Zip/Postal:  
Email:  *
Phone:  *
How Did You Hear About Us?
  * (Google, Yahoo, Etc)
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please indicate the nature of your appointment:
 Dental Care  Oral Sores / Lesions  Oral / Facial Pain
 Other (please briefly explain below)
 
 



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