Patient Registration Form

Please register online and watch the Patient Videos. If this is not done prior to your arrival at the office, your appointment start time may be delayed.

If you provide an email address when making your appointment, you will receive an email from U.S. Health Records with your user name and password. Please follow the instructions to fill out your health history. If you did not provide an email address, you may still pre-register 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.

If you do not have high-speed internet available to you, you may register in our office waiting room prior to the day of your surgery.

Technical Note:

PC Users
Our online form uses the latest version of Adobe Acrobat Reader 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 least version 9 of the plug-in to successfully use our online form.

Mac Users
You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free plug-in from Adobe's web site.