Patient Registration
Complete Your Patient Registration Form
Complete Your Registration Online
Before your appointment, please complete your patient registration form online. Choose your preferred language below to access the secure form.
Once completed, please make sure to submit the form so your information is securely sent to our office.
Patient Registration
Select your preferred language to complete your secure patient registration form.
Complete Form in English Completar Formulario en EspañolOnline Patient Registration
Pre-Register Before Your Appointment
You may pre-register with our office by completing the secure online Patient Registration Form.
After completing the form, please make sure to press the Complete and Send or Submit button at the bottom of the form so your information is automatically sent to our office.
On your first visit, our team will have your completed form available for your signature.
Privacy & Security
Your Information Is Protected
The security and privacy of your personal data is one of our primary concerns. Desert Maxillofacial Center takes precautions to protect the information you submit through the online registration process.
If you have questions about completing the form or submitting your information, please call our office at 760-837-1515.
If you need assistance, contact our team before your appointment so we can help guide you through the registration process.
Helpful Patient Links
Helpful Patient Resources
Get Started
Need Help Completing Your Forms?
If you have questions about the patient registration form or need help preparing for your appointment, please contact Desert Maxillofacial Center in Rancho Mirage.