Online Forms

Our Office Staff

Patient Registration Form

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 Submit button at the bottom to automatically send us your information. On your first visit to our office, 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.

If you have dental insurance, please bring your card with you so we may make a copy for our records. If you have any questions, feel free to contact the office by phone at: 480-807-8022 or toll free at 877-900-3636 or by email at: info@superendo.com. Thank you, we look forward to meeting you.

Consent for Treatment & HIPAA

Please read and sign our Consent for Treatement & HIPPA Form. The treatment consent form allows us to do treatment in our office. The HIPAA consent form allows us to use your information in our office, with your insurance company, and with a referring doctors office. Remember to bring your forms to your appointment. If you have any questions regarding these forms, please wait to sign them until you come into the office and we'll be happy to answer your questions.

Adobe Acrobat Required

Our online forms use the Adobe Acrobat 5 Plugin to allow patients the convenience of completing their health history and registration forms from home or work. Please download the free plugin from Adobe's web site if it is not already installed on your system. It is important that you have at least version 5 of the plugin, in order to successfully use our forms.