PATIENT REGISTRATION

You may preregister with our office by filling out only the form that applies to you (only 1 FORM) on our secure online Patient Registration Forms.

Prior to your appointment a reminder will be send if the form has not been filled out on line. Click on the Online Patients forms link above. You will see the forms listed below. Click on the form that applies to you.

Form 1. New Patient registration form – For Pediatric New Patients only
Form 2. For Routine Check-ups – Only for cleanings and check-ups
Form 3. Covid-19 Questions – For patients that do not need forms 1,2 or 4 (i.e.: Ortho monthly patients)
Form 4. Adult Orthodontics New Patient – For new Adult Ortho-only patients that are 18 yrs or older

After you have completed the form, you will be prompted to go to the next form, choose the bottom below DONE 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.