Secure Online Registration
If you will be registering for treatment at our office, you may complete the online Patient Registration and Medical History form at your convenience. Patients are required to fill out both the Patient Registration and Medical History form before receiving treatment.
To view and complete the following forms, follow the link below.
- Click here to complete the Patient Registration and Medical History forms.
When you have finished filling out the forms, press the Submit button to securely transmit your registration form. After you Submit your form, you will have the opportunity to securely upload and send an image of your insurance card with your Registration form.
Please call us if your have any questions: Anchorage Oral and Maxillofacial Surgery Office Phone Number 907-562-9939.