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 Submit button at the bottom to automatically send us your information.

After you submit your form, you will have the option to attach an image of your health or dental insurance card.

On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

If you have any further questions, please call our office:
Dr. Hurst and Dr. Shirley in Nacogdoches: Nacogdoches Phone Number 936-569-1111 and Dr. Tate in Lufkin: Lufkin Phone Number 936-632-4444.

Contact Us Today

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.
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