Patients

PATIENTS

 

We did all of the heavy lifting so you don’t have to.

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 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.

How To Use Our Form

  1. Download our form
  2. Open the form in the free Adobe Reader program
    • IMPORTANT: The form will NOT send from your web browser, you must use the free Adobe Reader program
  3. Fill out the fields and click SEND to submit the form via the Internet
  4. Click Allow and Yes to approve any popup dialogues to complete the form transmission

Our Form

Alternative


  1. You may also print the form and bring it into our office

SMILE NOW, PAY LATER. GET PRE-APPROVED TODAY!

SIGN UP