Patient Registration Forms
You may preregister with our office by filling out our secure online Patient Registration Form. Please note, patient registration forms should be completed and signed by the patient if over 18 years of age. For minor patients under 18 years of age, forms should be completed and signed by the parent or legal guardian that will accompany the patient during the consultation and/or treatment.
Please select the link below that corresponds to the office in which you are scheduled. This will take approximately 10-15 minutes to complete. To expedite the process, please be prepared with your personal information including:
- Social security number
- Driver’s license number
- Dental insurance card
- Medical insurance card
- List of current medications
- Preferred pharmacy with phone number
After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it. Please bring your driver’s license and all dental and medical insurance cards with you to your in-office appointments.