Patient Registration

Please find below three forms that will need to be filled out prior to Dr. Thurgood providing you service. We ask that you print these completed forms with you upon your first office visit.

Patient Information Form
Patient Health History Form
Patient HIPPA Form
(please read our Notice of Privacy Practices for Protected Health Information prior to signing)

ORAL &
MAXILLOFACIAL SURGERY

2001 S SHIELDS ST, BLDG J3
FORT COLLINS, CO 80526
970.498.0196