Online 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 to our office, 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.

Technical Note:

Mac Users

You must open and submit the form in a Safari Browser and also have the latest Mac Operating System. It is important that you have the latest version of Adobe Reader on your computer in order to submit your form to our office correctly, please download the free plugin from Adobe's web site.

PC Users

Our online forms use the Adobe Acrobat 5 Plugin to allow patients the convenience of completing their health history and registration forms from home or work. Please download the free plugin from Adobe's web site if it is not already installed on your system. It is important that you have at least version 5 of the plugin, in order to successfully use our forms.

For your convience we've made the below forms available for you to fill out at home before your appointment. Please remember to bring these signed forms with you to your first appointment. If you submit your patient registration health history form above to our office we will have it available for you to sign at the time of your appointment.

Privacy Practices

This form, Notice of Privacy Practices, presents the information that federal law requires us to give our patients regarding our privacy practices. Please read and sign the Privacy Consent form.

Policies

• Insurance & Payment Policy