Please preregister with our office by filling out our secure online Patient Registration Form.
- The “Online Registration Form” button below will take you to our secure online registration form.
- To complete online registration, you will need the following:
- Patient Information
- Insurance Details
- Electronic Copy of Insurance Card for Upload (see below)
- Contact information for Other Doctors / Dentists Involved in Your Care
- Health History
- 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 signature.
*If the patient is under 18, we will also need information about the person responsible for paying the bill.
Frequently Asked Questions (FAQ)
How do I upload a copy of my insurance card or other document?
The easiest way to do this is with a smart phone. Just take a picture of your insurance card and email it to yourself.
You’ll then have a “.JPG” file that you can save and upload when needed.
There are many other ways to do this too. One popular way is to use a scanner. Many drugstores and office supply stores offer document scanning and can help, if you need it. The only restrictions are that the total size of all uploads is less than 60MB and the filetypes are graphical (GIF, JPG, TIFF, TIF, PDF, DEX) or Microsoft Word (DOC/DOCX)
What if I already have x-rays?
X-Rays should be no more than 12 months old.
X-Ray files can be emailed to email@example.com
If you have a hard copy X-Ray please bring it to your consultation appointment.
Do I need to bring study models to my jaw surgery consultation appointment?
Yes! Please bring your study models to your consultation appointment.
Can I mail my Study models?
No, it’s best not to mail study models. Please bring them with you to your consultation appointment.
Is online registration secure?
The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.