Patient Registration

Online Registration Form

You may pre-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.

After you have submitted the form, you will have the opportunity to securely upload and transmit an image of your insurance card.

Online Patient Registration

The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it. Please call us if you have any questions: Summit Dental & Orthodontics Phone Number 303-440-3300.

Technical Note

Clickable button to save and exit online patient forms

  Note to Patient: There is a “Save and Exit” feature on this form that allows 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 that you can setup and login at any time to finalize your registration form online.