The Finest,
State of the Art
Oral Surgical Care

Comprehensive Oral Surgery

New Patient Forms

Online Patient Registration

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 Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Patient Information Rights and Responsibilities

Please read our Notice of Privacy Practices, then print and sign our Acknowledgement form and bring it with you to our office. Federal law requires us to give our patients this notice regarding our privacy practices. If you have questions, please call us at: 919-567-3293.

Notice of Privacy Practices

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information.

Acknowledgement of Receipt of Notice of Privacy Practices

This form is used to acknowledge your receipt of our Notice of Privacy Practices, as well as to note your preferences for communication during treatments and follow up.

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