Patient Registration

New Patient Forms

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.

Online Registration Form button for Oral Surgery Patients

Acknowledgement of Privacy Practices (HIPPA)

Acknowledgement of Privacy Practices (HIPPA)

Financial Policy Form

Financial Policy Form

Medicare Advanced Beneficiary Notice

Medicare Advanced Beneficiary Notice

For more information about our registration forms or to schedule a consultation with Dr. Jackson, call our office in Olympia, WA at Oral Surgery Associates Drs. Dolgash & Jackson Phone Number 360-456-8610.