Ilmar Ezis, D.D.S., M.S.
Stacey Blume, D.M.D., M.S.
4030 Smith Road, Suite 225
Cincinnati, OH 45209
Phone: ( 513) 871-8488
Fax: (513) 871-8490
topgums@fuse.net
Patient Registration Forms
You can save up to 20 minutes if our office by filling out your patient registration and health history forms from the convenience of your own home. Simply click the link below to download a PDF that you can use to fill in your information.
Download Patient Registration Forms Here
Contact Form
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