Patient Registration Forms

General Dentistry

You may preregister with our  General Dentistry office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data are one of our primary concerns, and we have taken every precaution to protect it.

General Dentistry Patient Registration

Pediatric Dentistry Registration

Pediatric Dentistry Patient Registration

Download Pediatric Dentistry Registration Paperwork HERE!

Orthodontic Dentistry Registration

Orthodontic Dentistry Patient Registration

Download Orthodontic Dentistry Registration Paperwork HERE!

Note to Patient: Upon filling out your first name, last name, email, and at least one phone number field (a valid home or cell phone), a button will appear in the upper right corner titled “Save and Exit“. This button allows you to save and exit your form to complete at a later date. The system will send a registration email to the email provided on the form, so that you may set up a login to go back and finalize your registration form online.

File upload interface — “Attach Files” for patient submissions

Attaching files to your form submission:

Upon submitting your registration form, you will have the opportunity to attach and update additional files such as scanned copies of your driver’s license, Insurance Cards, a list of current medications, or other pertinent medical documents.