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 Submit button at the bottom to automatically send us your information. Please complete these forms in their entirety as our system does not have the option to save and continue later. 
The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Due to the Iowa Dental Board requirements, it is required that you wear a cloth face covering (mask, bandanna, scarf). This will help decrease the asymptomatic and presymptomatic transmission of COVID-19.

Online Patient Registration