Patient Forms Download and Patient Registration

You will find the Initial Examination will be very thorough.  Our experience shows that knowledgeable people make informed decisions and become our best patients with the most rewarding results.  Prior to your first appointment, please DOWNLOAD and COMPLETE the “Child Patient Packet” or the “Adult Patient Packet” below.  

So that Dr. Ziaja may spend extra time discussing his findings, it is important that you fill out the “Medical and Dental Health History”, “Get Acquainted” patient registration form and the “HIPPA Form to Complete” documents in advance.  Please bring the completed forms to the office on the day of your first appointment  or email them to [email protected] prior to your appointment.  The forms are in a fillable PDF format, so you can complete them in advance and save them on your device.  They cannot be saved or be submitted through the website.

Please click on the links below to view and download documents.

Dr. Ziaja’s Profile

Brochure Creating the Magic of Your Smile – For Life

Child Patient – Form Download and Registration Packet

Adult Patient – Form Download and Registration Packet

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