New Patient Registration

New Patients! Save time at your first appointment!
Request your registration forms by email in advance. Print them, fill them out at home, and bring them with you to your first appointment.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Email these forms to me! (Check those that apply.) *

Health History HIPAA Consent Form Patient Privacy Forms ALL FORMS

Best days and times for my appointments are... *

SUBMIT

Patient satisfaction is important!
Read what patients write about us!

"He truly cares about his patients. I had pretty bad experiences with some dentists where I live in NYC metro area. Dr. Schmuckler is very professional and honest and knows what is best for the patient. He is a Man of Integrity. My family drives down 2 hours to see him and we will do so continuously!"
–Kelsie in Edgewater, NJ, November 2015

"I broke a tooth and could not reach my dentist. A friend said call my dentist. So I did... they got me in that day and were so helpful I think I will change offices! I felt great in a new office... surprise... It was warm and comfortable and new tech equipment. Very good... So glad my friend told me to call."
–Katherine on Sep 25th, 2015

"I'm very happy with the care I've received from
Dr. Schmuckler. He's meticulous, caring and unrushed."
–Scott, a year ago

New Patients! Save time at your first appointment!Request your registration forms by email in advance. Print them, fill them out at home, and bring them with you to your first appointment.

New Patients! Save time at your first appointment!
Request your registration forms by email in advance. Print them, fill them out at home, and bring them with you to your first appointment.