Patient Forms

We utilize a 'touch-free' check-in and billing process.

In order for us to provide you access to the Patient Portal System (complete forms online, obtain yearly tax receipts, pay a balance, watch various treatment videos that the doctor or hygienist recommended, receive appointment reminders, etc.), we will need:

  • your email address
  • date of birth
  • address

Current patients

Please login to access your previously created Patient Portal.

New patients

Please call our office at (727) 321-1427, or we can send you an invitation email to the Patient Portal (check spam/junk as well).

  • Click on 'Log me In' which will open a screen to verify your identity.
  • The email address is locked down at this point and you will be required to enter your unique identifiers which need to be different for every patient.
  • You will then need to create a password that must be
    1. at least 8 characters long
    2. contain 1 capital letter
    3. contain 1 number
    4. contain 1 special character (! @ # $ % ^ & + =)
  • Retype the password and click 'submit'

Once you have logged in

  • Click on ‘Go to my forms’
  • Read, complete and sign any required forms before you arrive

If this is not possible

You will need to arrive 15 minutes early to fill out the forms through our kiosk. Email or call us if you have any questions.

Office Number: (727) 321-1427

We look forward to meeting you!


​Patient Registration

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