Patient Registration

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. 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.

Other Forms:

HIPAA - Click here

Financial Policy Statement - Click here

With StemSave, protecting your family’s future health by securing their stem cells today is easy and convenient.  StemSave works with us to recover the teeth at the time of an extraction to assure the highest probability of stem cell viability.  Simply register at https://www.stemsave.com/memberenroll.aspx and StemSave sends one of its patented transport kits to us prior to the planned procedure.  At the time of the extraction, we will deposit the extracted teeth into the kit.  The kit is then sealed and rushed to StemSave’s laboratories where the teeth are processed and the cells tested for viability.  Upon positive viability, the cells are cryopreserved to be available for utilization in future personalized regenerative therapies. 

To learn more about how you can secure your family’s future health by banking their stem cells, call our office today or visit  https://www.stemsave.com/memberenroll.aspx