Patient Registration

Online Registration for Dr. Zak Family Dentistry Patients in Simi Valley

If you need a dental appointment with Dr. Zak Family Dentistry, start here!  To request an appointment, fill out the form below by clicking on the link.  We will reach out to you ASAP to confirm your appointment date and time.

CLICK HERE TO SAVE TIME AND REGISTER ONLINE

Because you are submitting personal information, we have provided a secure server. This secure server software (SSL) encrypts that personal information before it is sent to us.

Download Patients Forms for Dr. Zak Family Dentistry Office

The forms below are formatted in the pdf format.  Please click on the link to complete it and bring it with you to the office. We look forward to seeing you!

To view the dental forms you must have Adobe Acrobat Reader installed. If you don't have it, install Adobe Acrobat Reader by clicking on the link.

Call 805-520-5830 to make an appointment

or contact us using this form:

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Sign up to get a Complimentary Cleaning

We know that you have many options when choosing dental care for you and your family.

To prove to you that Dr. Zak Family Dentistry is right for you, we invite you to experience our dental care first hand by receiving your first Prophylaxis Dental Cleaning (ADA Code D1110) on us.

FREE OF CHARGE TO YOU!

Thank you for signing up!