Samir F. Zakaria, D.D.S., M.S.D.
Periodontics
Livonia, MI
734-542-9904
  • Home
  • PATIENT INFORMATION
    • Introduction
    • First Visit
    • Scheduling
    • Financial Policy
    • FAQ
    • Patient Registration
    • Surgical Instructions
      • Pre-operative Instructions
      • Post-operative Instructions
  • PERIODONTAL DISEASE
    • About Periodontal Disease
    • The Mouth-Body Connection
    • Preventing Gum Disease
    • Oral Hygiene
    • When to See a Periodontist?
    • Women and Periodontal Health
    • Oral Pathology
  • SERVICES
    • Treatment Methods
    • Scaling and Root Planing
    • Bite Adjustment
    • Bone Grafting
      • Overview
      • Jawbone Health
      • Jawbone Loss and Deterioration
      • About Bone Grafting
      • Ridge Augmentation
      • Sinus Augmentation
      • Socket Preservation
    • Reduction Surgery
      • Osseous Surgery
      • Gingivectomy
      • Frenectomy
    • Gum Grafting
    • Crown Lengthening
    • Guided Bone and Tissue Regeneration
    • Dental Implant Options
      • Dental Implants
      • Computer Enhanced Treatment Planning
    • Cosmetic Periodontal Surgery
    • Oral Cancer Exam
    • Sedation
    • Bruxism Treatments
    • Local Delivery of Antibiotics
    • Supportive Periodontal Treatment ( Maintenance)
  • REFERRING DOCTORS
    • Referral Form
    • Links of Interest
    • Continuing Education
      • Meetings
      • Lunch and Learn
  • MEET US
    • Meet Dr. Zakaria
    • Meet our Staff
    • Office Tour
  • CONTACT US
    • Contact Information / Office Map
  • Photo Gallery

PATIENT INFORMATION

  • Introduction
  • First Visit
  • Scheduling
  • Financial Policy
  • FAQ
  • Patient Registration
  • Surgical Instructions
    • Pre-operative Instructions
    • Post-operative Instructions

Patient Registration

You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

online registration form

Print-Only:

  • Smile Analysis Form
  • Patient Medical History Details

Notice of Privacy Practices
        This notice describes how health information about you may be used and disclosed and how you can get access to this information.

Please review it carefully. The privacy of your health is important to us.

In our efforts to comply with the Health Information Privacy Act, HIPPA, we need to be certain that we guard your privacy according to your wishes when it comes to your family, friends and co-workers.

  • Notice of Privacy Practices Policy
  • Acknowledgement of Receipt of Notice of Privacy Practices
  • Consent For Use and Disclosure of Health information

 

Dr. Samir F. Zakaria, Diplomate, American Board of Periodontology,
Your Livonia Periodontist and Dentist Proudly Offers the Following Periodontal & Dental ImplantServices:
Scaling and Root Planing, Bite Adjustment, Bone Grafting, Osseous Surgery, Gum Grafting,
Crown Lengthening, Guided Bone and Tissue Regeneration, Dental Implants, Cosmetic Periodontal Surgery,
Oral Cancer Exam
, Sedation Dentistry, Bruxism Treatments


Serving Livonia, Detroit, and the Following Michigan Cities:
Novi MI • Farmington Hills MI • Northville MI • Plymouth MI • Canton MI


Samir F. Zakaria, DDS, MSD
37619 Pembroke Avenue • Livonia, MI 48152
Phone: 734-542-9904 • Fax: 734-542-9906


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