Oral & Maxillofacial Surgery of the Palm Beaches

Below are is the registration form. Please submit the form online or complete a print the forms for your initial appointment.

Online Registration Forms:

Click here to Register Online - complete registration will walk you through filling out 2 online forms and verifying that you have read our Notice of Privacy Practices & Payment Information.
BEGIN ONLINE REGISTRATION >>

Print Forms:

Click here to Print complete Registration Package - includes 4 pages; Patient Information form, Patient History form, Notice of Privacy Practices, and Payment Information. PRINT >>

Individual Documents

Here are documents of information regarding our Privacy Practices and Payment Information. You can also access the Patient Information and Patient History forms individually if you should need to re-print these pages separately.

Patient Information ONLINE | PRINT
Patient History ONLINE | PRINT
Notice of Privacy Practices READ | PRINT
Payment Information READ | PRINT

Click here to download FREE Adobe® Reader® 8 software to more securely view, print, search, sign, verify, and collaborate on PDF documents, online as well as offline, from your home or office.

Dr. Rolf B. Wolfrom, DDS, PA