Online Scheduling
Patient Registration Form - Adult
 

Anna T. Lukic D.D.S., M.S., P.A.

Patient Registration Form - Child
EXISTING PATIENTS-Medical History Update Form
MEMBERSHIP BENEFITS

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 look over your form and hit the "submit" button.   The security and privacy of your personal data is our upmost concern and we have taken all precautions to protect any information that you enter.  This link includes: Patient Information, Health History, Dental History and other required forms

You may fill out your updated medical history form prior to your annual dental cleaning/check-up.  After you have competed the form, please make sure to look over your form and hit the "submit" button.  The security and privacy of your personal date is our upmost concern and we have taken all precautions to protect any infomration that you have entered.  This link includes: Medical History Update

The link above includes our membership benefits that we offer our patients without dental insurance.  If you have any questions, please do not hesitate to ask at 704-209-9913.