614.436.2277
825 High Street
Worthington, OH 43085
Matthew S. Niemiec D.D.S, M.S.
Alexandra Smolik D.D.S, M.S.
Practice Limited to Endodontics

Patient Registration

Patient Registration

Please download and complete our Patient Medical History and Registration Forms. After you have completed the form, you may print it out and bring the completed forms with you. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it..