In order to make the process more convenient for you, please fill out and submit our Online Patient Registration Form.
- Online Patient Registration Form
Patients – Use the Sign Up Now option on that page.
If the online form is not working, then print out and complete the New Patient Form using the link, below:
Please bring the completed form with you to your appointment.
Temporomandibular Joint Disorder (TMD)
For your convenience, we accept Visa, MasterCard, and American Express. We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at (435) 658-0678. Many times, a simple telephone call will clear any misunderstandings. Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage. Most insurance companies will respond within four to six weeks. Please call our office if your insurance company does not respond within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated.
If monthly payment options are preferred, we are proud to offer financing through CareCredit and Lending Club for our patients. Contact us or click the related link to learn more about these options.