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98-76 Queens Blvd., Suite P-1, Rego Park, NY, 11374
For appointments and inquiries, please call:
(718) 897-3400


PATIENT REGISTRATION FORM
By registering, you agree to allow us to give you a call to perform a follow-up.

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EMPLOYMENT INFORMATION

IN CASE OF EMERGENCY INFORMATION

FOR MINORS


PRIMARY INSURANCE INFORMATION

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Please provide the address of the person responsible for the insurance if it is different from the patient.


AUTHORIZATION AND TERMS OF CONDITIONS

NOTE:
48 hours is required for appointment changes.
Insufficient notice such as canceling on the same day of your appointment will result in a charge of $75.00.
Submitting this document means that you agree that you are responsible for deductibles, co-payments and services not covered by your insurance.
Only in cases of family emergencies and sickness will the $75.00 fee be waived.
Through this policy, we hope to safeguard your time as well as the doctor's time.
Terms stated above are subject to change without prior notice.

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About Dr. Maria Supnet-Gozun,DDS


Dr. Maria Gozun, DDS has been a practicing dentist for more than 25 years and is recognized as one of America's Top Dentist for 2012 - Verified by Consumer's Research Council of America.

She's a graduate of New York University and University of the East-Philippines. She keeps her professional experience updated by being a member of the Academy of General Dentistry.

Visit her at her office to experience what it means to get personalized treatment and great patient care.

What We Do


Our office provides all general dental services, examinations, diagnostics, and dental treatments catering to all ages.

Our Services
Our Team
Our Office
Office Schedule
Directions
Insurance and Payment Providers

Contact Us


Telephone: (718) 897-3400
Fax: (718) 897-3401

98-76 Queens Blvd., Suite P-1
Rego Park, NY, 11374
(corner of 66th Ave., & Queens Blvd.)

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