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.

Kernersville Office

English Registration


Online patient registration button

Spanish Registration


Online patient registration button

Bermuda Run/Advance Office

English Registration

Online patient registration button

Spanish Registration

Online patient registration button