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

Additional Patient Forms

• Notice of Privacy Practices
• Patient Acknowledgment & Consent
• Watermark Questionnaire

• Request an Appointment & Preparing for Your First Visit
• Insurance Information & Payment Options
• What Patients Are Saying
• Get Driving Directions