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Patient Registration

To expedite your initial visit we have online registration forms. You may either download a paper copy and bring it to your initial visit or fill it out online and e-mail it to us. Directions for both forms are available online.

Patient Form Package
The link below will allow you download all the forms as one complete package.

Download Download the Patient Form Package.

Indivdual Forms
The links below allow you download the same forms contained within the Patient Form Package (above) on an individual basis.

Download Download the Notice of Privacy Practices form.

Download Download the Acknowledgement of Receipt of Privacy Practices form.

Download Download the Financial Responsibilty form.

Download Download the Patient Consent form.

Download Download the Guardian Release form.

Download Download the Insurance Inquiry form.

Download Download the Dental Insurance form.

Download Download the Patient Information form.

Download Download the Medical History form.

Download Download the Cancellation Policy form.

Download Download the Smile Survey form.