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Houston Oral Surgery Patient Forms

Online Patient Registration Forms

You may pre-register with our oral surgery office by filling out our secure online patient registration form. After you have completed the form, please make sure to press the submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it. You can view our notice of privacy practices to find out more about the steps we take to protect your personal information. 

Patient Registration View our Notice of Privacy Practices

Please download our Receipt of Notice of Privacy Practices form. After downloading, please print the form, fill it out, and bring it to your appointment with us.

Acknowledgement of Receipt of Notice of Privacy Practices