Patient Forms
Patient Registration Forms
You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Nuestro formulario en español
Imprima y complete este formulario y tráigalo con usted a nuestra oficina.
HIPAA privacy notice
HIPAA is the federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs.
Medical Records Release Form
Authorization for medical record release and disclosure of health information.
Medical Records Release Form
Download, print, complete, and return this form to VOSclinical@valleyoralsurgery.com or via fax (see office fax numbers in website footer below).