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.
Your Privacy Is Protected
This form is HIPAA-compliant and meets all requirements for the secure handling of your personal health information. To protect your privacy:
- End-to-end encryption ensures that your responses are securely transmitted.
- Only authorized personnel will have access to your submissions.
- We do not share or sell your information to third parties.
By completing this form, you can feel confident that your information is handled with the highest level of privacy and care in accordance with federal HIPAA standards.
*Understand that any omission of necessary health information can endanger your life during surgery and lead to lethal complications.
**Social Security Numbers are needed to verify coverage of insurance benefits.
This form should take 5-10 mins.
