Oral Surgery Patient Registration

Oral Surgeon Deer Park, IL

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. After you click the Submit button, you will have the option to securely upload and transmit an electronic version of your medical and/or dental insurance card.

clickable button that loads a secure online Patient Registration form

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.