Enter a Patient Health History

Enter a Patient Health History

Please read the information below before proceeding.

Thank you for selecting us to provide dental care for your family. So that we may better serve you, please complete this questionnaire. Clicking the “Proceed” button below will deliver you to our secure server. The forms are protected with 128-bit encryption and all submitted information is confidential.

Submitting Information for Multiple Patients: If you are submitting information for more than one person, please fill out a unique form for every new patient. Once you complete each form, click the “Submit Another Patient’s Information” button to start a new patient form with the same address, billing, and insurance information.

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Office Location


 
Karen Gordon, DMD
Address : 3990 Sheridan St. Suite 216
Hollywood, Florida 33021
Tel : (954) 613-9837
Fax :(954) 987-2098
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Office Hours

Monday
8:00 am - 5:00pm
Tuesday
8:00 am - 6:00pm
Wednesday
8:00 am - 5:00pm
Thursday
8:00 am - 5:00pm
Friday
8:00am - 1:00pm