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.

Thank you for your interest in Donald H. Currie General and Cosmetic Dentistry. Please fill out the form below and one of our staff members will set up a date and time convenient for you.
We take measures to ensure that your privacy is protected. Please read our privacy policy for more information.
Name*
First Last
Email*
Enter Email Confirm Email
Phone*
What is the reason for your visit? Or do you have any questions you want addressed during your visit?
Please do not use this form to send confidential personal health information. This form uses email, which is not a secure form of communication.
Are you a new patient?*
- Yes
- No
What search term did you use to find this website?*
Did you check any online reviews to help you pick our dental office?
- Yes
- No
Have you looked at our practice Facebook page yet?
- Yes
- No
Would you be interested in participating in a short survey by telephone? If selected, you will receive a $10 check for your participation.
- Yes I would
Comments
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