Online Forms

Patient Registration

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For more information regarding Oral, Facial & Implant Surgery in Charlotte, NC.
(704) 541-6070

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.

Patient Registration Form

Please Note:

Our online forms use the Adobe Acrobat 5 Plugin to allow patients the convenience of completing their health history and registration forms from home or work. Please download the free plugin from Adobe's web site if it is not already installed on your system. It is important that you have at least version 5 of the plugin, in order to successfully use our forms.

									Oral Facial & Implant Surgery Center • 11220 Elm Lane, Suite 100 • Charlotte, NC 28277 • (704) 541-6070
								

Dr. Priveer Sharma is a Board Certified Oral & Maxillofacial Surgeon in Charlotte, North Carolina. He is the Director of the Outer Loop Education Study Club, an affiliate of the Seattle Study Club, which actively provides national, regional, and local continuing education to the dental community of Charlotte. Dr. Sharma is recognized by multiple national groups for his expertise in Dental Implantology, Bony Reconstruction, Facial Reconstruction, and Outpatient Anesthesia.