Patient Registration

Image 9Prior to meeting with your oral and maxillofacial surgeon and as part of your initial consultation or first visit at our clinic, you will be asked to complete a patient registration form. This short patient registration form is a confidential medical questionnaire consisting of a few questions with regards to your condition(s) and overall health.  For convenience purposes, we would like to allow you to complete it in the comfort of your own home by clicking on the following link.  After completing this questionnaire form, you will have the option to either submit it to us electronically, or print it and bring it with you on your appointment day.

Confidential Health Questionnaire

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If you have any questions or concerns with the completion of this form, please contact us. We look forward to meeting you!
*Please note that our patient’s personal information is kept private and confidential. All information submitted in this online registration form will be treated by the clinic as part of your confidential patient record. Total privacy and confidentiality is ensured for both the patient and doctor.