Patient Registration

Thank you for choosing Enduring Smiles. We look forward to taking care of your dental needs.

In order to streamline your first visit to our office, click and print out the new patient forms and HIPAA Privacy Forms (below).

• Click here to download a PDF with the Registration Forms

Please fill the forms out and fax them back to our office at 610-892-8844 or bring them with you to your appointment.

To transfer x-rays from a previous office, please fill out and submit the following form to your previous practice.  

• Click here to download Patient Transfer Form.

When you arrive for your appointment, your paperwork will already be filled out and you can go in for services without waiting. Please call our office at Media Office Phone Number 610-892-9088 to make an appointment and if you have any questions or need assistance filling out your forms.