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).
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
For ongoing communication with our office, please add the following to your e-mail whitelist: surgicalarts.net, dentalsenders.com, aesthetique.net
Technical Note:
PC Users
Our online form uses the latest Adobe Acrobat Reader plug-in to conveniently submit the form from home or work. Please download the free plug-in from Adobe's web site if it is not already installed on your system. It is important that you have at the latest version of the plug-in to successfully use our online form.
Mac Users
You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free plug-in from Adobe's web site. You Must OPEN the Adobe Reader Application after installation and make Adobe Reader your DEFAULT SAFARI PLUGIN for Viewing PDF Files.