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 sign the bottom using your mouse then press the SUBMIT button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns, and we have taken every precaution to protect it.

  1. Covid Screening
    • If any answers to the screening are “yes” please contact our office for further directions.
  2. Covid Acknowledgement
  3. Financial Policy
  4. Patient Health History and Insurance Information-

    • This includes a copy of a photo ID, a copy of your medical insurance card, and a list of medications and supplements.
    • Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e., diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, and etc.) or if you are currently taking any medications (i.e., heart medications, aspirin, anticoagulant therapy, and etc.).
  5. Patient Referral Form with any associated images- 
    • If your dentist or physician has taken x-rays, you may request that they forward them to our office. If there is not enough time, please pick them up and bring them to our office. If additional films are necessary, they can be taken at our facility.