13131 Kings Lake Dr # 104, Gibsonton, FL 33534

DR KERA YOUNG | GIBSONTON PEDIATRIC DENTIST

Call us Today

813 829 9075

Patients

Dr. Young is Tampa Bay's Sedation Doctor!
Young Smiles Dentist uses Nitrous Oxide Conscious & IV Sleep Sedation.

Patient Forms

Online Forms

PATIENT FORMS

You can complete your patient forms online using our secure portal before your first visit. In order to complete these forms simply click the Patients Form button below. A new browser window will appear and you will be required to fill in your name and appointment request date. Once you hit submit you will be taken to a Patients Form page. You will see two forms:

1-Patient Registration Form
2-Medical History Form

Please note that you will need to click on both links and complete both forms. Once you click on the Patient Form link a pop-up window will appear for each form. Make sure you have completed all the questions in the form. Then click the submit button. Clicking the SUBMIT button indicates that you have completed the form. Once you click the SUBMIT button the pop-up window will disappear.

Once all the forms are completed, return back to our website by clicking the red “close” button on the Patient Forms page in the Portal.

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Get in Touch with us

Get in touch

Address

13131 KINGS LAKE DR # 104,
GIBSONTON, FL 33534

Phone

(813) 829-9075

Email

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