Patient Registration

  • Click Here to view and print our online registration forms. You can bring this information with you at your first visit, mail, or fax this information to us at570-368-2926. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
  •  Click Here to view letter from Dr. Harlacher concerning COVID-19.
  • Click Here  to view  COVID-19  Emergency Dental Treatment Consent form.

    Technical Note:

    You need Adobe Acrobat Reader to view our form. Please download the from adobe’sweb site if it is not already installed on your system.COVID-19 Emergency Treatment Consent (Generic)