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. 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 are one of our primary concerns and we have taken every precaution to protect it.

Privacy Policy

Deposit Policy Agreement & Cancellation Policy

  • Consult Only – $50.00
    *This fee is applied if you are going to cancel the appointment within 48-hour notice*
  • Consult and Surgery (same day) – this fee is $150.00
    *This fee is to be prepaid prior to scheduling this appointment*
  • Surgery/Procedure Only – this fee is 1/3 of the total of out of pocket expenses for the procedure.
    *This fee is to be prepaid prior to scheduling this appointment*

Any patient that is seen with any insurance other than Medicaid, you will need to adhere to this policy and can not make an appointment until we collect on this fee.

For Medicaid Patients, if you are canceling your appointment within 48 hours we have the option to deny rescheduling your appointment.

The deposit will be applied to rendered treatment/services and is non-refundable. If the appointment is canceled within 48 hours (2 days) of the appointment the deposit will remain on the account as a credit towards service rendered within 90 days of the deposit. The deposit must be used within 90 days otherwise it is forfeited.

Online oral surgery patient registration


New to Our Office?

Ready to Schedule Your Consultation with Dr. Russell?
Call The Maryland Oral Surgery Group Phone Number The Maryland Oral Surgery Group Phone Number 301-967-0183 today!