Patient Registration

Our office makes every effort to keep your visit on time and efficient so that we can maximize our time for the personalized care of your smile. For your convenience, our New Patient Forms are available for download below.

Please complete and print these forms at home before your first appointment. If you need assistance with downloading or printing these forms, please contact our office. We also have these forms in our office if printing is unavailable to you.

Please use the links below to select, download, and print out Patient forms. Fill out your information and bring all completed forms to your first appointment. If you need assistance with downloading or printing these forms, please contact our office. We also have these forms in our office if printing is not available to you. Please arrive 15 minutes early if you need to complete the forms in the office, thank you!

If you need assistance, please call our office at 267-202-0083.

We look forward to seeing you!

Technical Note

These forms are in PDF format and fillable. If you have Adobe Acrobat and a saved digital signature, you can complete, sign and email the forms back to us at: prestigedental@comcast.net If you do not have a digital signature, you can still complete the forms on your computer, print and sign them, and then scan and email them back to us. You can also manually print out the forms, fill them out by hand, and then bring the completed, signed forms back to the office for your first appointment. If you do not have Adobe Reader installed on your computer, you may download Acrobat Reader for free and use it to access these forms.