Patient Registration | Dearborn MI

You may preregister with our office by filling out our secure online patient registration form. Please make sure to complete each section of the form before submitting it. The security and privacy of your personal data are one of our primary concerns and we have taken every precaution to protect it.

New Patient Adult Registration

New Patient Child Registration

Online Registration Form button

Additional Patient Forms

Please call our Dearborn, MI office at Gary C. Veraghen, DDS Phone Number 313-563-5855 with any questions or to schedule your appointment with Dr. Blazo or Dr. Veraghen today!