Patient Registration

Filling out the required forms ahead of time will expedite your visit to our office, and often ensures more accurate completion.

To reduce the time spent in the office, please complete all patient registration forms ahead of your appointment. This helps us expedite your consultation and ensure the information is completed accurately. For questions regarding your registration, please contact our office at 317-846-4980.

Please download, print, and complete the patient registration form and HIPAA privacy form.

Bring both forms, your insurance information, payment, and x-rays or referral information from your dentist.

We look forward to seeing you soon!

Patient Registration Form
HIPAA Privacy form
big tooth with magnifying glass

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If you are an existing patient, this contact form should not be utilized for communicating private health information.