Online 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 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.

Technical Note:

PC Users
Our online form uses the latest version of Adobe Acrobat Reader to conveniently submit the form from home or work. Please download the free plug-in from Adobe’s web site if it is not already installed on your system. It is important that you have at least version 9 of the plug-in to successfully use our online form.

Mac Users
You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free plug-in from Adobe’s web site.

 
Patient Registration Forms and Info

The files on this page can be viewed as a web page, or as an Adobe Acrobat PDF file. PDF files can be saved to your computer for viewing offline and give you better control for printing them.

If you don't have Acrobat, you can download it by clicking this button

If you want to save any of the PDF files to your computer, right click on the link and then follow your browser's instructions to download the file.

(For example, in Internet Explorer, when you right click the file, you will see a list which has an option "Save Target As...", choose this option, then type in where you want to save the file.)

File
Description
INFORMATION AND INSTRUCTIONS

Letter to new patients

 
Explains our commitment to you along with how to prepare for your first visit.


Postwisdom

 This document describes what you should do following wisdom teeth surgery


Instructions for Our Surgical Patients

  
These are general instructions following surgery


IV Sedation and Anesthesia

 Discusses how anesthesia is used for oral and maxillofacial surgery


Nutrition Guide for Post Surgical Patients

 Eating can still be fun even after surgery! This guide tells you how to maintain good nutrition after surgery.
FORMS


Patient Registration Form

This form is to be filled out prior to your first visit.
By clicking on the PDF file, you can fill it out online and then click the Submit button to file your form online.
(You can then close the window and will be back here)

If you have any problems viewing the PDF form, you can view it as a web page, print it and bring it in on your first visit to our office.
Financial Policies
 This form is regarding our financial policies. Please print the form and bring a signed copy with you on your first visit.
Medicare Private Contract
 This form is regarding our Medicare policy. You may fill it out, sign it and bring it with you on your first visit.