Patient Registration - NIAGARA DENTAL IMPLANT & ORAL SURGERY

Patient Registration

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 Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

The Notice of Privacy Practices, below, presents the information that federal law requires us to give our patients regarding our privacy practices.

The Notice of Privacy Practices is in a pdf document which requires the Adobe Reader software. You most likely already have this software on your computer. However, if you have difficulty reading the notice, please click here to install Acrobat Reader.

Don’t hesitate to reach out to us with any questions.

Request your consultation today.

I understand the information disclosed in this form may be subject to re-disclosure and may no longer be protected by HIPAA privacy regulations and the HITECH Act.