Patient Registration

Please note: Due to COVID-19 we are now requiring all new patients to register online before your consultation appointment. Regardless if your consultation is done virtually by TeleDentistry or an in-office appointment. This will save time and limit contact. After you have completed the forms, please make sure to press the Submit button at the bottom to automatically send us your information.

* If you are unable to use online registration, please let our office know for further instructions.

The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Novi Office Registration:

Patient Registration

Livonia Office Registration:

Patient Registration

Sterling Heights Office Registration:

Patient Registration

South Lyon Office Registration:

Patient Registration

Mac Users
CLICK HERE TO REVIEW STEP-BY-STEP INSTRUCTIONS

PC Users
Our online form uses the latest Adobe Acrobat Reader plug-in to conveniently submit the form from home or work. Please download the free plug-in from Adobe’s web site if it is not already installed on your system. It is important that you have at the latest version of the plug-in to successfully use our online form.