Registration

 

You may print the registration, and medical & dental history forms below to complete at home in advance. This will  expedite your child’s registration at his/her first dental visit.

 

Registration Form (Online)


Registration Form (PDF Format)
Medical and Dental History Form (PDF Format)

If your child is covered by insurance, please email or call our office with the following information. This will allow us to verify insurance coverage and benefits in advance to save you waiting time at the office.
1) Basic information about your child/children (name and DOB)
2) Current phone numbers and/or emails
3) Insurance information consisting of insurance company, type of plan, subscriber’s name and group or ID number.

Thank You,    
Your friendly staff at Pediatric Dental Care