Patient Registration Forms

October 12th, 2012

Completing your patient registration and health history forms prior to arriving at our office will save you time at the examination appointment. Please print out the appropriate forms (below), fill them out, and bring the completed forms with you to our office.

Thank you.

Electronic Health History Form
Please fill this form completely to submit it. You do not have to print this form.

Health History Form (PDF Format)
Please print and fill this form and bring it to your first appointment.

Dr. Ajay Suri, DDS, MS Orthodontist [email protected] (501)821-5859 Toll Free: (855) 5-SURISMILE