Plainville, CT’s routine dental cleaning
and initial registration form

Do you need a routine dental cleaning? Are you a new patient with us? You may register with our office by filling out our secure online Patient Form below. After you have completed the form, simply press the Submit button at the bottom of the form to automatically send us your information.

On your first visit to our office in Plainville, CT, 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 via our secure server.