Online Patient Pre-registration

Pre-register for your Oral Surgery Appointment

To help insure accuracy and save time, you can pre-register HERE online before arriving for your first appointment. The information, including your medical history is transferred to our secure servers using a HIPAA compliant protocol to protect your personal information.

You may also print out the registration form and medical history and fill it out beforehand, then bring it to the office on your first visit.

It is our goal to make the registration process as convenient as possible for you.

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.

Patients with Insurance

Gilford Online Patient Registration

Portsmouth Online Patient Registration

Rochester Online Patient Registration

Patients with No Insurance (Self Pay)

Gilford Online Patient Registration (Self Pay)

Portsmouth Online Patient Registration (Self Pay)

Rochester Online Patient Registration (Self Pay)

Note to Patient: Upon filling out your first name, last name, email and at least one phone number field (a valid home or cell phone) a button will appear in the upper right corner titled “Save and Exit” . This button allows you to save and exit your form to complete at a later date. The system will send a registration email to the email provided on the form, so that you may setup a login to go back and finalize your registration form online.