Patient Registration

You may preregister with our office by filling out our secure online Patient Registration Form. 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.

Patient Registration

• Acquaintance Information Form
• Consent to SHARE Dental Records
• Hipaa Privacy Practices
• Acknowledgement of Receipt of Privacy Practices
• Medical History Form
• Record Request