Patient Registration

Patient registration includes two steps.

1) Print and Complete medical and dental history forms and submit

2) Print and complete the required Notice of Privacy Practice Act, Informed Consent form, Financial Acknowledgment and Release form, Facts you need to know, Dental Materials Fact Sheet and Restorative and Hygiene Appointment form.

Step 1)  Please download and Print to fill out your health and dental history form to expedite your visit.

 

Your privacy is very important to us. The registration form is on a secure system with encryption to ensure your information is never shared with anyone but us.

Step 2)  Please use the links below to download or print the following forms:

Note: To use the above forms, you will need Adobe Reader version 9.0 or above. If you need to download Adobe Reader, please click the button below: