Patient Registration in Florissant

New Pediatric Patient Online Forms

From the first day you join our office, we will cater to your dental needs. As part of your first visit with us, you will fill out a comprehensive medical and dental history. These forms are important because they help us to determine the course of your treatment. We have to know about allergies, sensitivity to anesthetics, long-term medications, etc.

Secure Online Patient Registration

Register from your home before your appointment! Use the button below to access our secure online new patient forms. After completion, please click the Submit button. You will then have the opportunity to upload and transmit an image of your insurance card. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it. For assistance, please call us at Florissant Pediatric Dental Office Phone Number 314-830-9663.

Begin Secure Online Patient Registration

If you would like a video appointment, please use our Virtual Appointment Request form. For your convenience we’ve included links to other new patient forms for you to download and print, as needed. For assistance, please call us in Florissant at Florissant Pediatric Dental Office Phone Number 314-830-9663.

Photo: Young smiling boy

Technical Note

The Privacy Policy form is in PDF format. If you do not have Adobe Reader installed on your computer, you may download Acrobat Reader for free and use it to access this form.