Oral Surgery Patient Registration

Forms for New Patients

Please see the patient registration/forms section of our website.  You will be able to complete most of your registration forms on-line.  All information is HIPPA/PHI protected and secured. 

Oral Surgery online patient registration

     If you are unable to complete your registration forms on our website, you will be provided the forms on your first visit.  The following forms are required to be completed:

     a.  Patient Demographic form

     b.  Patient privacy act form

     c.  Patient consent to photos form

     d.  Patient financial and assignment of benefits form.

     e.  Patient Health History form

     f.  Appropriate Informed Consent Forms and Anesthesia Forms. 

Call Southern Pines Oral & Maxillofacial Surgery Center Phone Number 910-725-1403 today to schedule your consultation with Dr. Almony