Patient Forms

DENTAL TREATMENT CONSENT FORM.docIf you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Financing Care Credit

Financial Policy

Patient Smile Interview

Periodontal Questions

HIPPA Discloser

HIPPA Authorization

 





 

 

 

 

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Testimonials

"One of the best practice in the state of Florida. I inspect and train hundreds of Dental and Medical practices annually and Dr Vergara's office is always exceeds Federal and State of Florida requirements for sterilization and infection control procedures".

Archie Jennings Total Healthcare Compliance

" La atencion al paciente me parece Excelente, me gusta por su buena tecnologia y tambien por su experiencia, calificandolos del 1 al 10 con un 10"

Jairo Andres Caceres.

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Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the contact form below.