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Patient Registration Forms


If you are a new patient, or if you have been asked by our office to update your forms, please click on the secure link below (Online Registration Form) to fill out the forms. Once completed & signed, please make sure you click on the "Complete and Send" button at the bottom right of the form. This will ensure that it is sent to us securely and automatically.

If you have any trouble filling out the online form, please call our office.

We appreciate your help in filling out these forms in the convenience of your own home before your appointment. This expedites your check-in process and helps reduce your time at the office.





Our HIPAA Privacy Policy can be read here

Please review this notice carefully for detailed information regarding our HIPAA privacy practices. This document is referenced in the section "Acknowledgement of HIPAA Notice of Privacy Practices" of the Online Registration Form above. You have the right to review our Notice before signing this Acknowledgement/Consent.
Location
27 Bridge St
Stamford, CT 06905-4501

Phone
(203) 325-2661

Hours
Monday-Friday: 8:15am - 4:30pm
Saturdays: By appointment
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Stamford Oral & Maxillofacial Surgical Arts | www.stamfordoms.com | (203) 325-2661
27 Bridge St, Stamford, CT 06905