Overland Park Dentist - Patient Registration

>> Your Overland Park Dentist at Overland Park Smiles, provides outstanding cosmetic dentistry, dental implants and migraine treatment to patients of all ages in Overland Park, KS.

12870 Metcalf Avenue, Overland Park, KS. 66213


	(913) 851-8400

Patient Registration

	HOME
	SMILE MAKEOVER GALLERY
	MEET THE DOCTORS
	OUR TEAM
	OFFICE TOUR
	PATIENT SERVICES
	LUMINEERS (VENEERS)
	INVISALIGN (INVISIBLE BRACES)
	FINANCIAL OPTIONS
	HOURS & LOCATION
	APPOINTMENT REQUEST
	COSMETIC CONSULTATION
	PATIENT SURVEY
	HELPFUL LINKS
	CONTACT US

For your convenience, we have supplied our patient registration forms in two formats.

Simply click on the links below to choose between the printable pdf version or the online patient registration version. Please call our office if you have any questions.

Patient Registration Form Package (pdf)

Online Patient Registration

The Health Insurance Privacy and Portability Act (HIPAA) is a federal law designed to protect your personal health information. Willits & Woltkamp Family and Cosmetic Dentistry is HIPAA compliant. For your convenience, we have provided a printable version of our HIPAA Notice of Privacy Practices and Acknowledgement forms. For new patients, please print, sign and bring the Acknowledgement form to your first visit.

New Patient Offer
Receive a FREE Consultation for Cosmetic Dentistry or Healthy Gums.

Refer-a-Friend Offer
In appreciation of your confidence in us and referring a friend, you will be rewarded with a $50.00 Gift Card, and your friend will receive a $50 credit on their account.

Offers Expires: Sep 06 2010

Simply complete the form below. Thank you.