Patient Registration

Online Patient Forms

You may pre-register with our office by filling out our secure online Patient Registration forms. After you have completed all four pages of forms, please make sure to press the Submit button at the bottom to automatically send us your information.

After you Submit the forms, you will have the opportunity to securely upload and transmit images of your dental or medical insurance card.


Clickable button to launch a secure, online Oral Surgery Patient Registration form

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

For assistance, please call our office: Chranberry Township Oral Surgery Office Phone Number 724-779-7999.