Online Forms

Patient Registration Form

Yes, you can save time during your initial consultation!  You might even be able to save money by using your insurance benefits! 

Simply preregister by filling out our secure online form for the Grapevine, Irving or Keller office. After you have completed the form, please print it, then 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.

Technical Note:

Our online forms use the Adobe Acrobat 5 Plugin to allow patients the convenience of completing their health history and registration forms from home or work. Please download the free plugin from Adobe's web site if it is not already installed on your system. It is important that you have at least version 5 of the plugin, in order to successfully use our forms.

Other Forms

• HIPAA Notice
• Available Financing (Care Credit)
• Employment Application Form
• Dental Implant Self Quiz
• Corrective Jaw Surgery (Orthognathic)
• TMJ Evaluation Form
• Obstructive Sleep Apnea Syndrome Evaluation Form