Patient Registration

Online Patient Information and Medical History Forms

You may preregister with our office by filling out our secure online Patient Registration forms. Please fill out all four pages as completely as possible.

After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information.

After you have submitted your form, you will have the opportunity to securely upload and transmit images of your insurance card.

Clickable button to launch a secure, online Oral Surgery Patient Registration form

 
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. For assistance, please call our office: Fargo Office Phone Number 701-232-9565.