You may preregister 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.


Patient Survey

We appreciate you taking the time to complete our survey. Please feel free to comment on your visit as well. Any comments you choose to make are kept strictly confidential and can only help us become better in the future.

Full Name:

Email Address:

How would you rate your overall visit?
Excellent Very good Average Not so good

When your appointment was over did you have a good understanding of your dental visit?
Yes Not really I wish I knew more about my visit

Were your financial options explained to you?
Excellent Very good Average No so good

Did you have to wait over 15 minutes past your appointment time to be seated?
No 15 to 30 minutes 30 to 45 minutes over

Was our staff caring and friendly?
Excellent Very good Average Not so good

Did cleanliness and infection control of our practice meet your expectations?
Excellent Very good Average Not so good

Were your fears about dental procedures listened to, discussed and cared for?
Excellent Very good Average Not so good

Would you refer your friends and family to us?
Yes No I'm not sure

Please comment on how we could make your visit better, new services you would like to see, or other ways we can make you feel more comfortable: