Patient Registration

 

New Patient Form

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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.

 

A Checklist for Your First Visit

As an Associates in Oral Maxillofacial Surgery patient, your initial visit will be a consultation to understand your diagnosis and treatment options. While there are times when the option to perform surgery on the same day are available, a complex medical history or treatment plan may require your procedure be scheduled on a separate day.
 
For the first visit, please provide us with the following:

  • Your Referral Slip
  • X-Rays [if applicable]
  • A complete list of medications you are currently taking
  • Your insurance cards [for any medical and/or dental insurance]

 Patients under the age of 18 must be accompanied by an adult or guardian at all appointments.

 
If your procedure is scheduled on the same day as your consultation and you will be undergoing IV anesthesia, please: 

  • Do not eat or drink during the 8 hours prior to your procedure
  • Arrange to have an adult accompany you and drive you home

 
Please bring to the attention of your doctor if you:

  • Have a medical condition of potential concern, such as diabetes, high blood pressure, rheumatic fever, artificial heart valves and joints, etc.
  • Are currently taking any medication