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New Patient Forms

(813) 814-4000

Tampa Dental Spa - Dr. Beatriz Ribeiro-Totzke

Dear New Patient,

Please click the link below to DOWNLOAD the New Patient Forms:

Welcome Form   Medical History   HIPAA   Informed Consent   Financial Agreement   Disclose to Family

  • Carefully read all forms
  • Fill out the forms completely and accurately
  • Sign and Date all forms
  • Send the forms back to our office PRIOR to your scheduled visit: 
    • Deliver them in person: we'd love to meet you!
    • Scan and email them to: Subject: <Your Name> FORMS 
    • Fax to the office 813-814-9933
    • Mail the original forms to our office:


11333 Countryway Blvd

Tampa, FL 33626

Thank you for your confidence in our office, we look forward to assisting you with all your dental needs.     "The Green Team"       

Healthy Smiles

What does your smile say about you? Let us help you radiate confidence with a healthy smile.



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