Online Patient Registration

You may preregister with our office by filling out our secure online Patient Registration Form. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

After completion of form, please print, then submit. Bring printed copy with you to your appointment. Minors must be accompanied by parent or legal guardian to consultation appointment(s) and procedure appointment(s).

• Download Our Patient Registration Form

Additional Forms for all New Patients to Download:

• Financial Policy
• Patient's Rights
• Disclosure of Healthcare Information
• Notice of Privacy Practices for Protected Health Information -- English
• Notice of Privacy Practices for Protected Health Information -- Spanish

Additional Patient Specific Forms to Download

Please print out and complete pertinent forms below.

• Dental Implant New Patient Questionnaire
• Orthognathic (Jaw) Surgery New Patient Questionnaire
• TMJ/Facial Pain New Patient Questionnaire
• Cosmetic New Patient Questionnaire

Third Party Financing

• Care Credit
• Citi

For ongoing communication with our office, please add the following to your e-mail whitelist: surgicalarts.net, dentalsenders.com, aesthetique.net