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.

Attention Patients

Dental Insurance companies now require patients being treated in an Oral Surgery Practice to have a current & digital panorex image (An X-ray that captures the entire mouth in a single image, including the teeth, upper and lower jaws, joints, surrounding structures and tissues) when submitting a claim to be paid.

If not, they have the right to deny any & all payments on your claim. If for some reason you are opposed to doing a panorex (and we respect your decision), we can collect fees in full, submit your claim & then if the insurance company pays send you the payment. Our goal at MOSAIC is to give you the best care & experience possible. If you have any questions, please don’t hesitate to ask.

Thanks for allowing us the opportunity to serve you.

Online Registration Form

Printable Registration Form