DENTAL EMERGENCY? telephone call 833-925-8326
DENTAL EMERGENCY? telephone
PLEASE ANSWER THE FOLLOWING QUESTIONS BELOW:
Do you have dental insurance?
YES NO

In order for us to present you with the correct selection of plans please specify (Yes or No) if you have Dental Insurance.

Please check all that apply to You
I have or have had dental cavities

My gums bleed occasionally


ZAK DENTAL OFFICES IN CALIFORNIA