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  New Patients
You want your teeth to be with you a long time...just like your dentist. You can count on "A" Dental Centers being there today and tomorrow.

"A" Dental Centers now makes the first time visit even easier !
New patients can save time and frustration by filling out our new patient registration form in the comfort of your home.

  Patient Registration Form
As a new patient, "A" Dental Centers require you to submit a completed New Patient Registration Form detailing personal information and any medical conditions. As a service to you, we are supplying the forms online for you to print and fill-out prior to your visit.

PDF(13KB/3 pages)

To obtain the Patient Registration Form:

For Netscape Users:

  1. Click the "New Patient Form" button above.
  2. To Save the PATIENTREG.PDF file, select SAVE from the browser FILE menu.
  3. To Print the PATIENTREG.PDF file, select PRINT from the browser FILE menu.
  4. Click the browser BACK button to return to this page.

For Internet Explorer Users:

  1. Right-click the "New Patient Form" button above.
  2. To Save the PATIENTREG.PDF file, select SAVE TARGET AS from the menu.
  3. To Print the PATIENTREG.PDF file, select PRINT TARGET from the menu.
To view the New Patient Registration Form, you need Adobe Acrobat Reader.