* We highly recommend all our patients to fill out the registration form online and send it to us via email at firstname.lastname@example.org
To fill out the registration form please follow these steps:
Select the 'REGISTRATION FORM' button to download the form on your device
Fill out the form either electronically or manually - Make sure to save the completed electronic form before sending it to us
Email us the completed form at email@example.com
Call or email us to confirm your appointment once you send the completed form
We will print out the forms in our office and have them ready for you to sign upon your arrival at our office
Pre-Appointment Screening Form
All Patients are required to review and sign the screening form prior to their appointment.
Patients who have any symptoms of COVID-19 or have been in close contact with a COVID-19 patient will be referred to special facilities. Our staff or dentist will call you to review the pre-screening form with you.
You don't need to print this form. Our staff will have you sign this form upon your arrival. You will need to sign this form upon each entry.
Patient Acknowledgement Form
To protect our patients and our team, we require all our patients to review the COVID-19 acknowledgement form prior to their appointment. You don't need to print this form. Our staff will have you sign this form upon your arrival. You will need to sign this form upon each entry.