Patient Forms

You will then be prompted to a window with links to the two patient forms. Please notice the instructions on this page: "All forms that are submitted before this window is closed will be for [Patient Name]. If this window is closed and then reopened, subsequent submissions will be treated as if they are for a different patient."

Form 1 titled 'Patient Registration Form' consists of 8 sections including: General Info, Responsible Party Info, Primary Dental Insurance, Dental Info, Consent for Services & Financial Policy, HIPAA Acknowledgment and Consent for Internet Communications.

Press ‘1. Patient Registration Form’ to begin.

Complete all required information.

Once all 8 sections are completed, press the ‘Submit’ button.

The form window will automatically close and you will return to this screen.

You should then immediately continue to form 2, ‘Medical History Form(2).’

Complete all required information.

Once this form is completed, press the ‘Submit’ button.

The form window will automatically close. You may now close out of this screen and attend your scheduled appointment at ease knowing your required paper work has been completed.