Welcome to SolutionZ! We have provided you with various forms below. Simply download and print the PDF form on
this page, fill it out, sign it and bring it to your appointment. It's that easy!

1. NOTICE OF PRIVACY PRACTICE
2. ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICE
3. GET ACQUAINTED QUESTIONNAIRE
4. INSURANCE INFORMATION
5. INSURANCE GUARANTEE OF PAYMENT
6. PATIENT COSMETIC QUESTIONNAIRE
7. DENTAL SELF ANALYSIS QUESTIONNAIRE


Thank you for entrusting us with your medical and dental health, and welcome to our family.

Patients Welcome
727 / 535 6400
NEW PATIENT
FORM BINDER
Before and After Photos:
15950 Bay Vista Dr.
Suite # 390
Clearwater FL 33760