New patient registration

Request your first appointment

Tell the clinic who you are, why you need a dental visit, and which schedule works best. The clinic will confirm the final appointment after reviewing availability.

1. Patient details2. Medical information3. Appointment preference

Patient information

Enter the information that will identify the patient record.

First name Middle name Last name Birth date Sex Mobile number Email address Home address Emergency contact

Parent or guardian information is required for patients under 18.

Parent or guardian name Relationship to patient Guardian mobile number Guardian email address Guardian authority confirmationI confirm that I am the named parent or guardian and am authorized to submit this request for the minor patient. I understand that treatment consent is separate and will be completed before any procedure.

Medical and dental information

Share information that may affect safe dental care.

Known allergies Current medications Health information relevant to dental care

Appointment preference

Select your preferred visit. The clinic may offer another time if the slot is unavailable.

First visit is consultation-first. You may select the service or concern you are asking about, but the Doctor will examine you and confirm the appropriate care plan first. No treatment charge is created from this request. Emergency concerns may be assessed and treated on the same day when clinically appropriate.

Service needed

Who should provide the dental care?Choose an available doctorAfter you select a time, the system will show only dentists accepting new patients who can provide the selected service.Let the medical clinic decideThe clinic will assign an appropriate available doctor when staff confirms the request.

Preferred date

Choose a service to see the next available dates and times.

Preferred available time Available doctor

Choose the preferred date and time first. ClinicCare will then show only doctors who can accept that service at the selected schedule.

Urgency Alternate date Alternate time Reason for visit or main dental concern

Schedule notice: This is a preferred time only. It is not reserved until the clinic confirms the appointment.