Patient Registration
Complete Your Patient Registration Form
Online Patient Registration
Pre-Register Before Your Appointment
You may pre-register with our office by completing the secure online Patient Registration Form.
After completing the form, please make sure to press the Complete and Send or Submit button at the bottom of the form so your information is automatically sent to our office.
On your first visit, our team will have your completed form available for your signature.
Forma de Registro de Paciente Nuevo
Para su conveniencia, puede completar la forma de registro de paciente nuevo en línea antes de su primera cita.
Después de completar el formulario, asegúrese de presionar el botón Submit al final para enviar automáticamente su información a nuestra oficina.
En su primera visita, tendremos su formulario completado disponible para su firma.
Privacy and Security
Your Information Is Protected
The security and privacy of your personal data is one of our primary concerns. Desert Maxillofacial Center takes precautions to protect the information you submit through the online registration process.
If you have questions about completing the form or submitting your information, please call our office at 760-837-1515.
If you need assistance, contact our team before your appointment so we can help guide you through the registration process.
Helpful Patient Links
Helpful Patient Resources
Get Started
Need Help Completing Your Forms?
If you have questions about the patient registration form or need help preparing for your appointment, please contact Desert Maxillofacial Center in Rancho Mirage.