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Comprehensive Dental Services, P.C., Queens
  • External link opens in new tab or windowQueens Location 718/271-2500
  • External link opens in new tab or windowEmergency/Text 917/822-7711

Supermoon 2020



Things to do to prepare for Teledentistry Evaluation, Fill out forms below and Submit



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664693
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               Informed Consent




I am acknowledging that I wish to receive a teledentistry consultation with my dentist.  In the absence of radiographs (x-rays), I understand that I may be asked to send photographs or other documentation as requested by the dentist.  I will try to provide as much detailed if I can. I understand that the doctor is limited to what they are to  determine n these circumstances. I also understand if I am experiencing pain or swelling that is life threatening, I will call 911 or go to an emergency room. I understand that I am responsible for any payment resulting from this consultation that is not covered by a dental insurance plan.


Place Initials to confirm that you have read, then click Submit Form




664693
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Dental Insurance Information


Your Name

Insurance Company Name

ID#

Group#

Insurance Company Address




Two Locations

94-18 59th ave
Suite E3
Elmhurst, NY 11373


2171 Jericho Turnpike
Suite 235
Commack, NY  11725




External link opens in new tab or windowSchedule a Teledentistry Evaluation

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Queens location will now be text messaging you from our cell number, 917/209-9616 add us to your contacts.  Feel free to contact us by text message at any time.

Please text 917/822-7711 for any dental emergencies.




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  • External link opens in new tab or window7182712500
  • External link opens in new tab or windowinfo@drgrillo.com
  • External link opens in new tab or window94-18 59th ave, suite E3, Elmhurst , NY, 11373
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