When filling out the form below, you are registering your child as the patient, please enter his/her first and last name on the first page. Parents names and contact numbers should be registered under the emergency contacts. To complete the enrollment process, you will be required to enter a form of payment under your child’s account. Your first payment will be the $120 enrollment fee billed at your first visit. If you have any questions please do not hesitate to call the office and we would be happy to help answer any questions.