New Patient Forms

Your smile is one of the first things people notice about you. Dr. Rogers and his team are committed to providing you with
quality healthcare and a smile you will love. With the latest technology and the most advanced techniques, we offer
comprehensive solutions for our patients’ oral health needs. Believing in the importance of listening to our patients, we take the time to truly understand each person’s needs, goals, and lifestyle. By providing the best possible care for your family, you become a member of our dental family. We love to see you smile!

Save time in the office by filling out our secure online patient registration forms from the privacy of your own home. Please email the completed document to our office or bring it with you at the time of your appointment.


Most of us believe that our medical and other health information is private and should be protected, and we want to know who has this information. The Privacy Rule, a Federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information. The Privacy Rule applies to all forms of individuals’ protected health
information, whether electronic, written, or oral. The Security Rule is a Federal law that requires security for health information in electronic form.


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