Thank you for scheduling an appointment with us! At the bottom of this page , you will see the word DENTICON. Please click on the email address below that.
Read the HIPPA outline and then click " I Agree" (our full HIPPA policy will be presented to you at our office). You will arrive at our registration form.
Fill out Patient Registration name, address, birthdate, etc.
Skip the dental insurance portion of the form by clicking "NO" to Do you have primary dental insurance? We will complete that information for you once your
registration is received by our office.
For the Medical Alerts portion of the form, click the box marked "Yes" for all the health issues that apply to you. You can leave the "No" areas of the form blank.
Continue on to the Dental Questionnaire and fill in as many of the areas that apply to you.
At the bottom of the form click "No to all medical alerts," then click "Confirm registration." This will send your form to our office to complete the registration process.
In addition, we request that you call your previous dental clinic to have them email our clinic your most recent bitewings and full-mouth xrays and/or panograms.
Please give them our email address: email@example.com.
Thank you, and we look forward to meeting you!
Dr. David McKay, Dr. Tara Regenold, and the rest of the staff
Mon - 7:30AM - 4:30PM 4800 Nicollet Avenue
Tues - 8:00AM - 5:00PM Minneapolis, MN 55419
Wed - 7:30AM - 4:30PM Phone (612) 822 -2176
Thurs - Administrative Day Email: firstname.lastname@example.org
Fri - 7:30AM - 2:00PM