Online Patient Registration

To all patients of Innovative Implants and Periodontics,

Due to recent public health concerns, Drs. Mandel, Joseph and Versteegh are actively monitoring information from the Center for Disease Control and Prevention (CDC) regarding the spread of COVID-19 (Novel Coronovirus Disease).  The safety of our patients and staff is always our top priority.  As such, we have established screening measures and are continuing to follow stringent infection prevention protocols.  We ask all patient and visitors to notify us in advance if they feel they are at risk for COVID-19 and to take preventative measures for the safety of themselves and others.

If you have flu or cold-like symptoms such as a cough with fever, newly developed shortness of breath, if you have recently traveled to a Level 3 area, including China, South Korea, Iran or Italy, or have been in contact with someone who has contracted the coronavirus, please call us at (410) 363-3780  to reschedule your appointment as recommended by the CDC.

As a safety precaution to our staff, patients and our community as a whole, we are unable to treat patients who present with any of the above stated symptoms.  In addition, individuals who have recently visited a Level 3 area are required to remain at home for 14 days to confirm that no signs of the virus are present.  Therefore, we will require a two-week waiting period for an appointment if you have traveled to an area with Level 3 coronavirus epidemic, or if you have been in contact with someone who is ill with this virus.

We sincerely apologize in advance for any inconvenience,

Drs’ Mandel, Joseph and Versteegh and Team

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.

save-exit
Note to Patient: There is a “Save and Exit” feature on this form, that would allow you to complete any portion of this form at a later time before submitting this information to our office. At a minimum, you will need to input your first name, last name, DOB, email and at least one phone number field (home or cell phone). Once this is filled out, you will notice a button labeled “Save & Exit” appear in the upper right hand corner of the form . If you choose to select this button, our system will send you a registration email which you can setup and login at any time to finalize your registration form online.

 

Information and Consent for Periodontal Implant Treatment
Consent for Periodontal Treatment