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NEW PATIENT FORMS

Please prepare for your first appointment by completing our new patient information forms.

Download these forms to your computer to complete at home and then bring them with you to your first appointment.

Medical History Form Financial Policy HIPAA Consent Form Appointment Policy Insurance Guarantee of Payment and Financial Form

Locations

5010 Gunn Hwy, Tampa, FL 33624

Phone: (813) 960-5869

Email: diezimages@gmail.com

  • MON - TUE8:30 am - 5:00 pm
  • WED8:30 am - 3:00 pm
  • THU8:30 am - 5:00 pm
  • FRI8:30 am - 1:00 pm
  • SAT - SUNClosed
Contact Us

3112 West Kennedy Blvd Suite A, South Tampa, Fl 33609

Phone: (813) 874-5869

Email: chris.southtampadental@gmail.com

Fax: 8138745821

  • MON - TUE8:30 am - 5:00 pm
  • WED8:30 am - 3:00 pm
  • THU8:30 am - 4:00 pm
  • FRI - SUNClosed
Contact Us

General and Cosmetic Dentistry of Tampa - Randall Diez and Michael Diez

Location

5010 Gunn Hwy,

Tampa, FL, 33624

Phone: (813) 960-5869
Text Us: (813) 960-5869

Email: diezimages@gmail.com

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