<%@ LANGUAGE="VBSCRIPT" %> <% if Request.ServerVariables("Content_Length") = 0 then %>

Home | Doctor & Staff | Services | Publications | Presentations | Contact Us

Dr. Anthony Farole, D.M.D.
Philadelphia, PA

Contact by Phone
Contact by Email

Main Office
Anthony Farole DMD
Suite W-2
191 Presidential Blvd
Bala Cynwyd, PA 19004
Second Office
111 South 11th Street
Suite 4140 Gibbon BLDG.
Thomas Jefferson University Hospital
Philadelphia, PA 19107
Phone: 610-668-3300
Fax: 610-668-4038
Your Name:

Time To Call:

Your Phone:

2^nd Phone:
Your Email:

Procedure:

Questions/
Comments:

If you would like to set up a consultation with the Doctor, please feel to contact us by phone at your convenience or simply fill out the e-mail form below and we will reach out to you.

Good luck and be well.

<% else HTML = "" & NL HTML = HTML & "" HTML = HTML & "" HTML = HTML & "" HTML = HTML & "" HMTL = HTML & "" HTML = HTML & "Procedure: " & Request.Form("subject") HTML = HTML & "

Message: " & Request.Form("message") & "

From: " & Request.Form("realname") & " (" & Request.Form("email") & ")" HTML = HTML & "
Phone: " & Request.Form("phone") & "
Alt Phone: " & Request.Form("phone2") & "
Call Back When: " & Request.Form("callbacktime") HTML = HTML & "" HTML = HTML & "" set mail = Server.Createobject("CDONTS.Newmail") mail.bodyformat = 0 mail.mailformat = 0 mail.to = "contact@drfarole.com" mail.from = "contact@drfarole.com" mail.subject = "DrFarole.com Contact Form Submission" mail.body = HTML mail.send Response.Redirect(request.form("redirect")) end if %>