Zack Dollar, DMD - Cosmetic and Implant Dentistry
Zack Dollar, DMD - Cosmetic and Implant Dentistry

Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

Patient Medical History Form

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

Patient Medical History Form
NEW PT paperwork.pdf
Adobe Acrobat document [1.4 MB]

Privacy Notice

Please read over and sign our Notice of Privacy Practices, acknowledging our privacy policy. This form should also be brought to your first appointment.

Privacy Notice Acknowledgment
Acknowlegment of Privacy Practices.odt
Open Office Writer [17.4 KB]
Appointment Policy
Appointment Policy.odt
Open Office Writer [16.2 KB]
Hipaa Notice of Privacy Rights
HIPAA.odt
Open Office Writer [27.0 KB]

Phone: (256)362-3456

Fax: (256)761-0970

 

E-mail:

info@zackdollardmd.com

zackdollardmd@yahoo.com

 

Address:

Zack Dollar, D.M.D.

107 N. Spring Street

Talladega, AL 35160

 

Hours of Operation

Monday-8:30-5:00

Tuesday-8:30-5:00

Wednesday-8:30-5:00

Thursday- 8:30-5:00

Closed Friday, Saturday, and Sunday 

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