New Patients

Patient Forms, Map and Directions to Tampa Office

Your first visit to Vivian Medina, DDS establishes a vital foundation for our relationship with you. During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor. To understand what to expect for your first visit to our practice, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There's also background information about our committed staff and our first visit procedures. You can even save some time at your first visit by printing out and completing the patient forms in advance of your appointment.

Mission Statement
Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.

To fulfill this mission, we are committed to:

  • Listening to those we are privileged to serve.
  • Earn the trust and respect of patients, profession and community.
  • Exceed your expectations.
  • Ensure a creative, challenging and compassionate professional environment.
  • Strive for continuous improvement at all levels.

Patient Forms
Please fill out these forms so we can expedite your first visit:

  • New Patient Paperwork - [PDF] | [ONLINE]
  • New Patient Paperwork - Spanish - [PDF] | [ONLINE]

In order to view or print the PDF forms you will need Adobe Acrobat Reader installed. Click here to download it.


The office of Dr. Vivian Medina is pleased to offer an In-Office Membership Program to our patients. 

We want to help you prioritize your oral health, and this program allows for a complete continuation of preventative care without involving any insurance companies, deductibles, co-pays, claims, waiting periods or annual maximums. It’s easier than insurance and can help you save some serious cash while working toward your healthy and beautiful smile. There are currently three membership types according to your dental needs. 

Call us for information regarding the Adult, Periodontal, and Child Plans!

Adult Plan

  • (2) Prophylaxis (routine cleaning)
  • Fluoride Treatment
  • (2) Oral Evaluations
  • Periodic Radiographs
  • (1) Oral Cancer Screener
  • Intraoral photos
  • (1) Emergency exam with x-ray

Up to 15% off additional basic restorative services. Major services will be eligible for a 10% prepay discount.

$564 Annually

Periodontal Plan

  • (4) Periodontal maintenance cleanings
  • Fluoride Treatment
  • (2) Oral Evaluations
  • Periodic Radiographs
  • (1) Oral Cancer Screener
  • Intraoral photos
  • (1) Emergency exam with x-ray

Up to 15% off additional basic restorative services. Major services will be eligible for a 10% prepay discount.

$744 Annually

Child Plan

  • (2) Prophylaxis (routine cleaning)
  • Fluoride Treatment
  • (2) Oral Evaluations
  • Periodic Radiographs
  • (1) Oral Cancer Screener
  • Intraoral photos
  • (1) Emergency exam with x-ray

Up to 15% off additional basic restorative services. Major services will be eligible for a 10% prepay discount.

$444 Annually


New Patient


What To Expect
Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctor. We look forward to your first visit.


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Our Location

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Hours of Operation

Our Regular Schedule

Vivian Medina, DDS

Monday:

8:00 am-5:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

8:00 am-5:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed