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We recommend all new patients register so that we may gather vital health history information.

If you wish to get a head start, please complete our PC-ready Health History Form (PDF). NOTE: you cannot save your work as a file, you must print it after completion. Please bring it with you on your first visit. If you'd like to fill out your registration by hand at our dental office, please arrive 15 minutes prior to your appointment.

You can fill this form out on your computer using Adobe Reader (external link).

Also available to print and sign is our privacy acknowledgement (PDF), and for your review, our privacy notice.
First name:
Last name:
E-mail address:
Phone number:
Existing patient? Yes  No
Confirm Appt by: Phone  E-mail
1st Choice:
Day and Time
2nd Choice:
Day and Time


* Latest time avail. for new patients
Type of appt. needed:
Comments, requests, or questions:
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