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 Complete and Send button at the bottom. You should see a “Thank You” that means that the information was successfully automatically sent to us. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Please review the following prior to completing the registration paperwork

 1.) Patients are required to pay any co-payment and/or co-insurance amounts at the time of service. In most cases we will collect 20% of our fees on the day of the procedure.

2.) Patients are also required to provide the correct insurance information during the registration process.

• You will all need to bring a photo ID and all the insurance cards to your appointment.

• If any of them need to be a digital card please email them to [email protected] prior to your appointment. We will need the front and back of each insurance card for proper insurance processing.

Pharmacy Information Section:

• Please include the pharmacy name, address and actual number to the pharmacy not just the store.
  • Missing information could cause a delay in your prescription.

 Insurance Information Section:

• We need the information of the person who carries the insurance.
  • Which might not be the patient.
• If you carry Delta Dental insurance, please include the state associated with your policy. 
  • Missing information could cause a delay in processing your claim.
  • Again please bring your insurance cards and photo ID to your appointment so we can make copies.

 Health Information Section:

• If you are currently taking an antibiotic given by your dentist or referring doctor for an infection, please do not click that you premedicate. Only patients who have been told by their primary care or surgeon to regularly take antibiotics before any dental work should list that they premedicate. This is typically done after knee or joint replacements or certain heart surgeries to prevent infections.

Below are links for the instructions for patients having  General Anesthesia / IV Sedation as well as after-care instructions for all patients having surgical procedures. 

Please open the links in blue below to review prior to surgery!

• Pre Anesthesia Instructions Highlighted
  • ALL patients having General Anesthesia / IV Sedation it is vital that you review entire document in the link above prior to your procedure.                                                                                    Remember most important are:
    • NOTHING to eat or drink a full 6 hours prior to surgery
    • Wear a short sleeve shirt
    • NO finger nail polish
    • Your driver will have to remain in the waiting room during the entire procedure.
  • These guidelines are imperative to follow for your safety during surgery. Should any of the pre- anesthesia instructions not be followed your surgery may be rescheduled. 
• Post Operative Instructions
  • ALL patients having surgery please review the entire document in the link above for the aftercare instructions prior to your procedure. This will allow you note any specific questions you may want to ask the staff while you are here.

Please keep in mind that having insurance is not a guarantee of payment. You are responsible to know your insurance coverage and will be responsible for any non-covered services.

Please be advised that you will sign paperwork acknowledging you reviewed this information at check-in.

Patient Registration