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Patient Registration Form | General & Cosmetic Dentistry in Raleigh, NC
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You may pre-register with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Please Note:
Our online forms use the Adobe Acrobat 5 Plugin to allow patients the convenience of completing their health history and registration forms from home or work. Please download the free plugin from Adobe's web site if it is not already installed on your system. It is important that you have at least version 5 of the plugin, in order to successfully use our forms.
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For your convenience, our Patient Registration Form can be downloaded on your computer and printed out for you to complete at your leisure. Please be sure to bring these completed forms, along with any x-rays and insurance information, at the time of your appointment. We look forward to meeting you!
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HIPAA Privacy Policy
This form, Notice of Privacy Practices, presents the information that federal law requires us to give our patients regarding our privacy practices.
This notice is a pdf document which requires the Adobe Reader software. You most likely already have this software on your computer. However, if you have difficulty reading the notice, please click here to install Acrobat Reader.
Click here to read the notice.
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