Online 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.

Shelby Office: Online Patient Registration

Anniston Office: Online Patient Registration

Carrollton Office: Online Patient Registration

Gadsden Office: Online Patient Registration


Alternatively you can print the patient registration document, fill it out in advance and bring it with you to your appointment. Please find our patient registration document by clicking on the link below:

Download Patient Registration Form

Download Patient Registration Form (Spanish)


Ready to Smile with Confidence?
Call or Request an Appointment Today!

Call Us Today!