WELCOME TO OUR NEW PATIENTS –
On this page we ask our new patients to supply registration, insurance and health history information.
New patients are asked to complete the below (off-line) registration , to the extent applicable, and bring the completed form to the office on their first visit. If you choose to email the off-line registration form to our office, please keep in mind that some email utilities are NOT secure . We encourage you to treat your completed registration form as you would any other private healthcare document.
HINT: Once you have clicked on the above “off-line registration” button, the form will be displayed on your computer screen. You then have (2) choices to proceed.
1. Right mouse click and instruct your computer to “print” the form. Manually complete the 5-page form and bring it to the office on your first visit.
or, for the tech savy…….
2. Fill out the 5-page form using your keyboard and the active highlighted fields. When complete, right mouse click and instruct your computer to “print” the form. Bring the completed form to the office on your first visit.
You can be assured that all information supplied to Shorey Family Dental, is secure and confidential; meeting all HIPAA (Health Insurance Portability and Accountability Act of 1996) compliance standards.