Patient Registration

CALL US - 954.941.2277


There Are Four Options for New Patient Registration

Select the Option Below That Best Describes You


I Use Outlook, Thunderbird, Eudora, etc.
Use this option ONLY if you have an email client software package such as Microsoft Outlook installed on your computer. You can click here to load our new patients registration form. To be sure this option will work for you, go to the bottom of the form and click the submit button - it should launch a new email to be sent to Carolyn@DrKenRoss.com with our new patients registration form attached. After testing, close the email, and start completing the form.

I Use GMail, Yahoo Mail, Hotmail, or WebPage-Based Email
Our new patients registration form can be saved to your computer. Click here and then save it to a location on your computer that will be easy to find later. Then, open the form that you saved, and fill out the form on your computer. Save the form with the changes you made. Now, log in to your online email account and create a new email addressed to Carolyn@DrKenRoss.com - and attach the newly saved version of the new patients registration form with your information in it, and send the email. If you need help in learning how to attach a form to an email, ask a friend, family member, or read the help section at your email providers website.

I Don't Have Email: Print Form, Fill Out, Bring In to Office
Please click here
and print the PDF form on your home or office printer. Then, complete the form and send to us via fax, mail, or bring in with you to your first visit.

I Am Not Able to Do Any of the Above - Complete The Form at the Office
Please arrive up to 45 minutes early, and we'll provide you a new patients registration form you can complete at out office.


 

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Kenneth E. Ross, DMD, MSD - Periodontics & Implantology - 2211 N.E. 36th Street (Sample Rd.) Suite 103- Lighthouse Point, FL 33064 • 954.941.2277
Copyright © 2009 South Florida Smile Restoration. All Rights Reserved. Video and Website by Breathless Video Productions.