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.
Note to Patient: Upon filling out your first name, last name, email and at least one phone number field (a valid home or cell phone) a button will appear in the upper right corner titled “Save and Exit” . This button allows you to save and exit your form to complete at a later date. The system will send a registration email to the email provided on the form, so that you may setup a login to go back and finalize your registration form online.
Or, if you would prefer, you may print out and fill in the below questionnaire and bring it to our office, No need to do both.
Please download, print, and complete the Dental Patient Data & Health Questionnaire form. We ask that you bring this completed form to our office for your initial visit.
Dental, Patient Data & Health Questionnaire
A document used to gather information about the dental health history of each patient.