Forms & Finance

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To reduce the amount of paperwork when you arrive for your visit, please complete our Patient Registration forms before arriving for your appointment and bring them with you. Whenever possible, we mail you these forms along with a detailed estimate prior to your surgery date so you can make appropriate financial arrangements before your visit. You may download and print copies of the Patient Registration Forms here on our website if you do not receive them by mail.

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.

Online Registration

 

Dental Office Referral


For referrals, please contact Prairie Oral Surgery with questions at mail@prairieoralsurgery.com

Fill out the following form and email it to the above.

 

Payment


Patient balances are due on the day you receive services. We do not finance patient balances beyond the date of service, but we do accept Care Credit as an outside financing option for you. For more information on Care Credit you can visit their website at www.carecredit.com or call them at 1-800-365-8295.