Bloomington Oral & Maxillofacial Surgery
Oral Surgery
 
812-323-9700
  • HOME
  • Patient Information
    • About Our Practice
    • Preoperative Consultation
    • Anesthesia Options
    • Scheduling
    • Financial Options
    • Insurance Information
    • Privacy Policy
    • Patient Registration - Online Forms
  • Procedures
    • Introduction
    • Extraction of Teeth
    • Dental Implants
    • Bone Grafting
    • Wisdom Teeth Removal
    • Orthognathic (Jaw) Surgery
    • Facial Trauma
    • Pre-prosthetic Jaw Surgery
    • Oral Pathology
    • TMJ Disorders
    • Sleep Apnea
    • Cleft Lip & Palate
    • Platelet Rich Plasma
    • Exposure of an Impacted Tooth
  • Meet Us
    • Meet Dr. Tate
    • Meet the Surgical Staff
    • Office Tour
  • Surgical Instructions
    • Introduction
    • Before Anesthesia
    • After Dental Implant Surgery
    • After Bone Graft Surgery
    • After Wisdom Tooth Removal
    • After Exposure of an Impacted Tooth
    • After Extractions and Biopsies
    • After Pre-Prosthitic Jaw Surgery
  • Referring Doctors
    • Introduction
    • Doctor Referral Form
    • Event Calendar
    • Dental & information Links
  • Contact Us
    • Contact Information / Office Map Bloomington
    • Contact Information / Office Map Martinsville



Patient Information

  • About Our Practice
  • Preoperative Consultation
  • Anesthesia Options
  • Scheduling
  • Financial Options
  • Insurance Information
  • Privacy Policy
  • Patient Registration - Online Forms

Online Patient Registration

You may preregister with our office by taking our online patient interview. You will be presented with an interactive question and answer presentation that facilitates form completion. This narrated interview system enables a more accurate form completion process. This presentation will save you time! It eliminates the need for you to fill out traditional health care forms in our office.



When you are ready to begin, click the "Register Online Now" button below. A simple question and answer process will commence. After you have completed the interview, the patient information collected is securely encrypted and sent to our office.

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.

If you wish to simply print out the form to complete, please click here.

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Serving The Following Indiana Cities:
Mooresville IN • Terre Haute IN • Greenwood IN • Columbus IN • Spencer IN


Address: 637 S Walker St • Bloomington, IN 47403 • Phone: 812-323-9700