Patient Forms

At IKON Dental Group, one of our goals is to have your dental experience be as smooth as possible. To achieve this, we have our patient forms online to save you time during your visit!

Medical and Dental History Form

Dr. Izaz Khan

Dentist at Ikon Dental Group

Dr. Khan holds a Bachelor's in Physiology and Neurobiology from the University of Connecticut, a Master's in Biomolecular Sciences from Central Connecticut State University, and a dental degree from the University of Connecticut School of Dental Medicine. He completed his residency in comprehensive dental care at the Samuel Stratton VA Medical Center in Albany, NY.

FIRST NAME*
LAST NAME*
EMAIL*
PHONE*
Procedure Of Interest*
INSURANCE PROVIDER*
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FIRST NAME*
LAST NAME*
EMAIL*
PHONE*
PROCEDURE OF INTEREST*
INSURANCE PROVIDER ** Not Accepting Medicaid or Husky ***
Message

Dr. Izaz Khan

Contact Us

Phone

Hours

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