For your convenience, click on the appropriate link below to complete your patient information form. This will take you to our new secure site, where you can safely fill out your information. Once completed, your information will be automatically encrypted and transmitted to our office securely!
New Patient Registration Form
Existing Patient Health History Update Form
Records Release Form
If you prefer not to use our secure online registration, you may print the documents below, fill out by hand, and bring to your appointment. Please note, we may not be able to verify your insurance benefits in advance if you choose this method, and payment in full for your dental care may be expected.
New Patient Registration Form - printable
Existing Patient Health History Update Form - printable
Records Release Form - printable
Thank you and please call our office if you have any questions.
This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.
Well, I would give 6 stars if I could. I’m not so fond of having dental work done (who is, really?) because it can be uncomfortable, but my latest appointment for crown work was about as comfortable as I can be without being on my couch at home — I’ve had plenty of work done in the past, some of it under heavy sedation, but Dr. Blazer and the team really made this visit easy for me. Not only would I recommend Dr. Blazer, but I already have to 5 of my close friends and colleagues (and I’m not done!).
Dr. Blazer and her staff are very caring people. To have a doctor call you in the evening to see how you are doing is almost unhear of and I appreciated her concern.