Registration Forms

In order to provide you with the best new patient experience possible, we offer the convenience of filling out our New Patient forms online, prior to your first appointment with us.  Providing information such as any medical concerns you may have or whether you have insurance or not, allows our team to make sure everything is checked out ahead of time and means less time for you in the waiting room!

Please click on the individual - Patient Information, Medical History and Dental History form buttons below and enter in as much of the information possible.

Please save a copy of the Notice of Privacy Practices and the Dental Material Fact Sheet for your review.

For dental benefits, please make sure to have at the least the subscribers id/SSN# & the patients D.O.B., along with the name of the insurance carrier.

Do not worry about entering your secure information as these forms are hosted on our practice management vendors servers and they encrypt the data using HTTPS over SSL. Remeber to hit the "Submit" button, after you complete each form. This will ensure that we securely receive all of the data and also allows us to sync it up with your chart.

Patient Information

Health History

Dental History

Dental Material Fact Sheet

Notice of Privacy Practices

COVID-19 Screening

Sleep Screening Questionnaire