New Patient Forms

Register Securely Online

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. After you have submitted your form, you will have the option to securely upload and transmit an image of your insurance card.

Online Patient Registration

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.

Please call our office if you have any questions: Jason A. Straw, D.D.S. and Associates Phone Number 916-933-3332 (Placerville, CA) or Placerville Office Phone Number 530-626-3300 (El Dorado Hills, CA).