Patient Registration

We value your time and want to make the most of your visit at Central FL Oral and Maxillofacial Surgery, PA. For your convenience, we encourage you to prepare and submit the registration forms online in advance of your appointment.  Please fill out the forms in their entirety, as all information requested is important for us to have.  If you have difficulty with the forms, please contact the office where you have your appointment for assistance.  If you encounter computer problems and are unable to submit  the form online, please print the fully completed form and bring it with you to your appointment.  If you do not complete your paperwork in advance and wait until your appointment to start preparing your registration forms, you will need to arrive at our offices 30 minutes prior to your appointment time in order to have time to complete the forms before your appointment.
Please note the following Doctors go with assigned paperwork and procedures. If you are not sure which Doctor you are seeing please give our office a call and we would be happy to assist you.

Oral Surgery– Drs. Crofton, Bower, Gies, Hall and Pryor

Oral Surgery Patient Reg

TMJ / Sleep Apnea – Dr. Loughner

TMJ / Sleep Apea Patient Reg

Note to Patient: Upon filling out your first name, last name, email and at least one phone number field (a valid home or cell phone) a button will appear in the upper right corner titled “Save and Exit” . This button allows you to save and exit your form to complete at a later date. The system will send a registration email to the email provided on the form, so that you may setup a login to go back and finalize your registration form online.