New Patient Registration

You may save time and pre-reregister in the comfort of your own home for your appointment with Dr. Childers.

Use the link below to print and fill out our New Patient Registration forms, which include a health and medications history, patient and insurance information, and patient consent.

After you have completed the forms, please make sure to bring it with you for your first appointment.

Call Periodontal Health Professionals at  Marlton Office Phone Number 856-983-5593 with any questions.

Technical Note:

You will need Adobe Acrobat Reader to view our form. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system.