Patient Registration Form

Online Dental Forms Atlanta GA

Patient Registration | Dental Wellness Plan

☀ Patient Information and Medical History

You may preregister 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.

Afterward you can press the download button and then print out your form to bring with you to the office. You may also securely upload and transmit images of your insurance card.

Clickable button to launch a secure, online Dental Patient Registration form

Please arrive 30 minutes early for your first appointment to complete Registration

On your first visit to our office, we will have your form available for your signatures. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Please call our office with any questions: Moores Mill Dental Atlanta Office Phone Number 404-351-5200.

☀ Dental Wellness Plan

Moores Mill Dental‘s Dental Wellness Plan, our “in-house” dental plan, is a great option for our patients without traditional dental insurance. Use the button below to securely sign up online for this plan.

Dental Wellness Plan

Call our office with your questions: Moores Mill Dental Atlanta Office Phone Number 404-351-5200.