Make an Appointment | New Patient Registration

If you are a new patient to our practice, please click here to complete our Patient Registration, Medical History and Dental History forms online. When complete, please click the SUBMIT tab to send the forms directly to our office online. If you desire, you may also print a copy by hitting the PRINT tab.

If you are unable to keep you scheduled appointment, please give us at least 48 hours notice.

Please use this convenient online form to request an appointment. One of our staff members will contact you to confirm details.

* please enter the word "active" in the code box below, so your message doesn't get deleted by our spam filter

Patient Name:
New Patient:	Yes No
* Email:
* Code (see note above)
Address:
Phone:
* Preferred Days:
* Convenient Times:
How did you hear about our practice?
Please indicate the search terms you used to find this website.
Comments:

This form has been created only to be used for those wishing to make appointments with Dr. Currie. All other inquiries will be ignored and deleted. If you are interested in link exchanges, please contact Infinity Dental Web by e-mailing jenni at infinitydentalweb dot com.