Patient Registration

Patient Registration

You may preregister with our 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.

To fill out your Health History Form and send it directly to us via email, please use the online registration form provided below: 

 

To print out your Health History forms to fill out by hand, please use the Printable Health History Forms provided below: 

Health History

Consent for Disclosure Form 

Privacy Practices

Call Prescott Periodontics & Implant Dentistry, PLLC Phone Number 928-778-2340 with any questions and to schedule an appointment.