Patient Registration

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.

Any patient 18 years or under MUST have a parent or legal guardian present for treatment.

Online Patient Registration

Call us at Birmingham Office Phone Number 205-870-9441 (Birmingham) or Tuscaloosa Office Phone Number 205-650-4700 (Tuscaloosa) with any questions about registering at our practice.