Patient Forms | Niagara Dental Implant & Oral Surgery

Patient Registration

You may preregister with our office by filling out a secure online Patient Registration form. After completing the form, please click "Complete and Send" at the bottom of the page to automatically submit your information to us. The privacy and security of your personal data are one of our primary concerns, and we have taken every precaution to protect it.

Online Patient Registration Notice of Privacy Practices

ADA Video

Request Appointment

For more information or to schedule an appointment, call us at (716) 276-3553 or complete the form.

What Happens After I Send My Message?

Our team will review your information.
A team member will contact you.
We'll work with you to schedule your service.

First Name*

Last Name*

Email*

Phone

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Online Registration Form

New Patient Registration