New Patients
What Will Happen On My First Visit?
Please assist us at the time of your initial visit to the office by providing the following information:
- Your referral slip and x-rays from your referring dentist.
- A list of medications you are currently taking (please note that you can fill out your patient registration and medical history form on our website.)
- If you have dental insurance, please bring any forms or insurance cards with you to the appointment.
Call Dr. Zakaria Office!
Periodontist Samir F. Zakaria, D.D.S., M.S.D. in Northville, MI practices a full scope of conservative non-surgical and surgical services for periodontal disease (gum conditions) and a full range of Dental Implant treatments. Contact us today to schedule an appointment!
Please Note: All patients under 18 must be accompanied by a parent or guardian at the consultation appointment.
Please notify the office if you have a medical condition or concern prior to surgery (e.g. artificial heart valves or joints, heart murmurs requiring pre-medication, severe diabetes, or hypertension).
We will complete an in-depth medical and dental health history and a thorough examination to measure for bone loss, loose teeth, bite, oral cancer screening, TMJ, and other signs of periodontal disease.
Browse Dr. Zakaria’s book to see what kind of results Dr. Zakaria can achieve with his minimally-invasive gum grafting technique!
Patient Forms
- Patient Medical History Form
- Financial Policy Form
- Notice of Privacy Practices
- Acknowledgement of Receipt of Notice of Privacy Practices
- Consent for use & Disclosure of Health Information
- Consent to Give Permission for Dental Health Information
Patient Information
- Learn more about our doctor
- Schedule An Appointment Online
- Prepare for Your First Visit
- Dental Insurance Information
- Payment Options
- Get Driving Directions