Please Regsiter Before Your Visit

Please complete your patient registration forms at least 48 hours prior to your appointment. Be sure to select the correct office location for your appointment. You will be instructed to key in your phone number and your special Access Code which was emailed to you.

After logging in, please complete the following sections:

Patient Information

Medical History

Informed Consent

Financial Agreements

HIPPA Policy

CBCT Consent

When you have completed all tabs, please click - Confirm and Submit.

Your information will remain confidential.

• Notice of Privacy Practices
• Root Canal Treatment Postoperative Instructions
• Pain Medication
• Informed Consent for Text Messages
• DeKalb Patient Registration
• St. Charles Patient Registration