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. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Forms for Print:

Mark R. Jensen, D.D.S. • Susan G. Penniston, D.D.S., M.S. • Bradford J. Pugh, D.D.S. • Matthew G. Del Mastro, D.M.D. • Philip J. Wadsworth, D.M.D.

3401 Hwy 169 N, Plymouth MN 55441 • Phone: 763-559-0859 Fax: 763-559-4356

12000 Elm Creek Blvd., Suite 240, Maple Grove, MN 55369 • Phone: 763-416-3619 Fax: 763-416-3695

3905 Silver Lake Road, St. Anthony, MN 55421 • Phone: 612-248-8330 Fax: 612-315-5378