Patient Registration

Online Dental Patient Forms

Please print and fill out the both pages of the Patient Registration forms below prior to your appointment. Once completed, please fax to 954-437-5642 or email to Kotch Dental.

If you are unable to fax us the completed pages, please arrive 15 minutes early with your completed paperwork. We look forward to meeting you!

For assistance, please call us at: Kotch Dental Office in Pembroke Pines FL Phone Number 954-437-4443.

Full HIPAA Privacy Rule

Office Hours

Monday:   7:30 AM–5:00 PM
Tuesday:   9:00 AM–7:00 PM
Wednesday:   8:00 AM–7:00 PM
Thursday:   8:00 AM–5:00 PM
Friday:   8:00 AM–3:00 PM
Saturday:   8:00 AM–2:00 PM
Sunday:   Closed

Technical Note

These forms are in PDF format. If you do not have Adobe Reader installed on your computer, you may download Acrobat Reader for free and use it to access these forms.