New Patient Registration

The welcome letter and three brief forms will get you registered for treatment in advance of your first appointment. Please read them, complete them and either mail them to us or scan them to our email at patientportal@chcrr.org. This will help us get your account set up and speed up the process for you.

• Please read our welcome letter before completing forms. Welcome Letter for New Patients
• Next, tell us about you:

Adults:  Adult 18+ Patient Information Form
Pediatrics: Pediatric Registration Form

• We’ll need this form to get your consent to treat you: Consent to Treat Form
• We’ll need this to gather information about your health history: Authorization to Release Healthcare Info
• If you will be seeking a referral to our Behavioral Health team, we will need this: Authorization to Release Behavioral Health Information

We want you to be aware of your rights, choices and how we use and share your health information:
Notice of Privacy Practices 

The welcome letter and four brief forms will get you registered for treatment in advance of your first appointment. Please read them, complete them and bring them with you, mail them or fax them to help us get your account set up and speed up the process for you.

• Please read our welcome letter before completing forms. Welcome Letter for New Patients
• Next, tell us about you: Dental Registration Sheet
• We’ll need some health history from you:  Dental Patient History
• We’ll need this form for consent to treat you: Dental Consent to Treat
• We’ll need this to gather information about your dental history: Dental Authorization to Release Healthcare Info

We want you to be aware of your rights, choices and how we use and share your health information:
Notice of Privacy Practices