Request an Appointment/Referral Form

At Foundation Endodontics, we understand that your time is valuable, and we strive to make scheduling as convenient and stress-free as possible—especially if you're facing a late-night or weekend dental emergency and need prompt care.

We review and respond to all online appointment requests as quickly as possible, including those submitted after hours, over weekends, or on holidays. (Note: Requests received after 10 PM are typically answered by 8:15 AM the next day.)

What happens after you submit your request:

Once we receive your information, we will:

• Send registration forms via email and/or text message.
• Book a tentative appointment slot for you.

Please don't worry if the tentative time doesn't perfectly fit your schedule—this is simply a placeholder to hold a spot on our calendar. Once we receive your completed forms, the appointment can easily be adjusted. If you'd require a different time, just reply by text or phone—we'll do our best to accommodate your needs.

For dental emergencies:

If you're experiencing pain, swelling, or another urgent issue, please mention it clearly in the notes section below and include the name and address of your preferred pharmacy. As an emergency-focused practice, we prioritize urgent cases and are often able to offer same-day treatment when desired.

Insurance and cost information:

• No insurance? We can usually provide a rough estimate of fees over the phone once registration is completed. For a more accurate estimate, please indicate the tooth number and email any recent X-rays to foundendo@gmail.com.
• With insurance? Obtaining a reliable good-faith estimate of your copayments, coinsurance, or out-of-pocket costs requires extra steps and time. This includes completing registration, submitting your insurance details, and verifying benefits by phone (which can only occur during regular business hours).

We always aim to balance two key priorities: getting you in for care as quickly as possible and providing as much cost transparency as we can. These can sometimes conflict, since detailed estimates take additional time.

To help us serve you best, please use the notes section below to tell us which is more important right now—speedy scheduling or a detailed cost estimate before your visit. Your preference will guide how we proceed. (A note of reassurance: Our practice fees are fixed and do not change based on this communication.)

Payment details:

Copayment (or full payment if uninsured) is due on the day of service. We accept credit cards, (Discover and American Express included), with a 3% surcharge added for credit card payments (Apple Pay and google Google Wallet are accepted). To avoid the 3% surcharge, we encourage payment by debit cards, HSA cards, Zelle or cash.

About our good-faith estimates (for insured patients):

A good-faith estimate is our best projection based on the information provided—it offers good visibility into expected out-of-pocket costs but is not a guarantee. You can generally rely on the overall treatment fees we quote (the total fee for our services). However, the exact breakdown between what insurance covers and your responsibility is determined by your insurer. Insurance companies sometimes reimburse less (or, less commonly, more) than anticipated. In those cases, your final responsibility follows the Explanation of Benefits (EOB) issued by your insurer, which is legally binding. On rare occasions, this may result in a small balance bill if certain codes are unexpectedly denied or underpaid. (Conversely, if insurance overpays and your copay is lower than estimated, we will promptly issue a refund to you.)