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. 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.

Patient Registration


New Patient Information

Upon your arrival to our office, our Patient Coordinator will cheerfully greet you and ask if you have completed our Patient Registration Paperwork and signed our Notice of Privacy Sheet. You may complete these in advance by clicking the links below as a courtesy to you so that you may utilize your time more efficiently.

Patient Registration Paperwork

Notice of Privacy (HIPPA)

f you are unable to fill out the forms prior to your visit, please allow additional time at our office (approx. 15 minutes). If you have any questions or concerns we will gladly assist you when you arrive.

Financing options will be discussed with our treatment coordinator. Should your insurance cover part of your treatment, we will assist in submitting the appropriate forms in order to maximize your coverage.

We want to thank you for considering Foothills Oral Surgery for your oral health needs. Our goal is to provide you with all the assistance you may need to make an informed decision regarding your oral and facial health care needs.