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Sal Longo D.D.S.

Northridge Professional Building
77 Quaker Ridge Road, Suite 211
New Rochelle, NY 10804
(914) 636-3366



Please fill out form to request an appointment. You will get your appointment via e-mail. While we try to fill requests in a timely manner, we do recommend calling 914-636-3366 if you have an emergency that requires immediate attention.

Please note that name and e-mail adress are required fields!
Name:
email address:

What days are you available? (Check all that apply)
Monday
Tuesday
Thursday
Friday

What times of day are best for you? (Check all that apply)
Morning (9am-11am)
Mid-day (11am-3pm)
Late afternoon (3pm-5pm)
Evening (5pm-7pm)

What is the appointment primarily for? (Check all that apply)
Routine exam & cleaning
Emergency (pain or discomfort)
Consultation
Cosmetic consultation

Any comments? (special considerations or previous problems)




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