Online 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 Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Please Note:

Our online forms use Adobe Acrobat 5 to allow patients the convenience of completing their health history and registration forms from home or work. Please download acrobat from Adobe's web site if it is not already installed on your system. It is important that you have at least version 5, in order to successfully use our forms.

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Created for Richard C. Wunderlich DDS, MS | Periodontics and Dental Implants in Canton, MI