CLICK SUBMIT ON THE TOP LEFT once you enter your information in each of the forms below. All information is kept confidential and NEVER solicited or released in compliance with HIPAA rules and regulations. Please wait a few seconds after submitting to ensure it goes all the way through.

New Patient Registration Form

New Patient Medical History Form

HIPAA Release

Records Release Form
(If you need to send records/X rays from another office)

Pain Screening Form
(If you are having tooth/jaw/oral pain)