Patient Registration Form

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. After you submit the form, you will have the opportunity to securely upload and transmit images of your insurance card. Please call our office with any questions:

Washington DC Office: (202) 223-3391

Rockville Maryland Office: (301) 468-0020

 

Note to Patient: Upon filling out your first name, last name, email and at least one phone number field (a valid home or cell phone) a button will appear in the upper right corner titled “Save and Exit“. This button allows you to save and exit your form to complete at a later date. The system will send a registration email to the email provided on the form, so that you may setup a login to go back and finalize your registration form online.

lobby of Washington Oral & Facial Surgery with sofa, chair and table

Consent Forms

Get to know us.

At Washington Oral & Facial Surgery, we know how to help you. Our board-certified surgeons and expert staff can provide the care you need to relieve the discomfort you feel.

Our Commitment

We are committed to providing the highest quality care in a comfortable and compassionate environment.

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