Patient Registration

You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit , we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Online Patient Registration

Online Request Form 

Health care facility , please use the link below to request service. 

Facility Request Form

Release Records

You may release records to our office by filling out our secure online Release Records Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. Prior to your first visit , we will have your records from your previous dentist . The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Record Release Form

Credit Card Authorization Form

Credit Card Authorization

Click Here to download our Notice of Privacy Practices TMD