Patient Registration

Please click on the link below to download our Patient Information Sheet and Medical History Form. Complete, sign, and bring with you on your next appointment.

Patient Registration Forms

We are located at:

2335 Knob Creek Rd., Suite 101
Johnson City, TN 37604
423-926-4167

Contact Us Today

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment. If you are an existing patient, this contact form should not be utilized for communicating private health information.

Privacy Policy
Your Name*
Your E-mail Address*
Your Phone Number
I am interested in
- Scheduling Appointment
Best Time for Appointment
- Morning
- Afternoon
Preferred Day of Week
- M
- T
- W
- Th
- F
How did you hear about us?
Comments/Questions
Preference
This field is for validation purposes and should be left unchanged.

Serving the Tri- Cities and surrounding areas