New Patients: (540) 288-4351
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New Patient Information - Harrisonburg, VA

New Patient Information

Online Form

Patient Registration

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 Complete and Send button at the bottom to automatically send us your information. 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

Insurance Waiver

Pre-Op Instructions

Post Operative Instructions

Syringe Instructions

TMJ Questionnaire

Registration Form

After you submit the form, you will have the opportunity to securely upload and transmit images of you insurance card. Please call our office with any questions: Shenandoah Oral & Facial Surgery, Harrisonburg in Rockingham County, VA, Phone Number: (540) 433-1751.

Office Hours:

Mon | 8:00am to 3:30pm
Tues – Thurs | 8:00am to 5:00pm
Fri | 8:00am – 3:30pm
Sat & Sun | Closed

Online Registration Form

HEALTHY SMILES ARE BUILT ON PREVENTIVE CARE

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