Patient Registration



*Note: this form may not be compatible with smartphones or tablets.  

Please register with our office by filling out our secure online Patient Registration Form below.  After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information.  (Some browsers will not  allow you to sign at the end, just submit and sign in our office.)  The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.


Patient Registration Form

Pinnacle Peak Oral Surgery & Dental Implants
8575 E. Princess Drive, Suite 217
Scottsdale, AZ 85255
Phone: 480-877-0546
Fax: 480-342-8008
Office Hours

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