FACILITY ENTRY QUESTIONNAIRE

New Dimensions Dentistry
Prior to your office visit please fill out this form and submit it. We would prefer that you do this on the same day of your visit. Thank you.

Samuel C. Pollina, DMD













Please press the SUBMIT button below to complete your response.

Thank you.

NEW DIMENSIONS DENTISTRY
Dentist - Pediatric Dentist - Dental Hygienist

Business Address
1253 Scalp Avenue
Johnstown, PA 15904

Phone: 814-269-9731
Email: ndd1253@gmail.com
newdimensionsdentistry.com