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Patient Registration | Dearborn MI

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 Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data are one of our primary concerns and we have taken every precaution to protect it.

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. Veraghen or Dr. Blazo today!