Save time and complete this form prior to your first visit with the office.
You will be asked to provide an office code to enter the site which is listed below. Click on the Patient Registration button, complete and submit it and then do the same for the Medical History. Be sure to complete all pages of the history. The form is complete when the send button appears at the end of the questionnaire. Be sure to answer EVERY question or you will be asked to complete the form once you arrive at the office.
We will text you a reminder of your appointment 1 day prior.
**Please contact your prior dentist and request all x-rays and treatment records be sent to us PRIOR to your initial visit.
They may be forwarded to us via e-mail: email@example.com
WRITE THIS CODE DOWN. YOU WILL BE ASKED TO PROVIDE IT ONCE YOU CLICK THE LINK. OFFICE CODE: SUMM-AFCE46