New Patient Forms
For your convenience, you can download the initial paperwork and bring it with you for your first visit. Our Patient Information Form is available below in Adobe Reader format.
Download New Patient Forms
Michael Bleyzer, DDS
14 Thiells Mt. Ivy Road
Pomona, NY 10970-3038
Right off of Exit 13 Palisades Parkway
Additional hours may be available by appointment
Serving entire Rockland County New York: Pomona, Suffern, Valley Cottage, New City, Congers, North Rockland Towns of Thiells, Stony Point, Garnerville, Haverstraw and West Haverstraw, and Tomkins Cove.