Request An Appointment Online

We encourage you to request an appointment either by filling out the form below or contacting our front desk at (408) 253-2296. Thank you for scheduling your next visit; we look forward to seeing you!

First Name
Last Name
Email *
Reason For Visit: *
Preferred Time: *

Available Friday by appointment only.
Our office is closed on Saturday and Sunday.
Preferred Date: *
Questions Or Concerns Regarding Your Visit:

Appointment Terms and Conditions

We kindly ask for at least 24 hours advance notice prior to canceling or rescheduling an originally confirmed appointment. Otherwise, a $50.00 missed appointment fee will be assessed to your account. Your appointment time is reserved exclusively for you. It is important for you to keep the scheduled date and time to properly complete your treatment with Miriam Acosta DDS.

A missed appointment is a loss to you (the patient), another patient (who could have been assisted), and our dedicated team providing dental treatments.

It is our primary concern to provide quality care to our patients and thus reservations are important part of how we can best assist you. By keeping your scheduled reservation, you are enabling us to better serve you and others. Thank you for your cooperation and understanding.

I accept the terms and conditions presented to me for requesting a dental appointment.

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