Charles B. Nissman, D.D.S.
Michael B. Salin, D.M.D.
Online Forms
Online Patient Registration
You may preregister with our office by taking our online patient interview. You will be presented with an interactive question and answer presentation that facilitates form completion. This narrated interview system enables a more accurate form completion process. This presentation will save you time! It eliminates the need for you to fill out traditional health care forms in our office.
When you are ready to begin, click the "Register Online Now" button below. A simple question and answer process will commence. After you have completed the interview, the patient information collected is securely encrypted and sent to our office.
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 is one of our primary concerns and we have taken every precaution to protect it.
Privacy Policy
This form, Notice of Privacy Practices, presents the information that federal law requires us to give our patients regarding our privacy practices.
Snoring and Sleep Apnea
Prior to your visit we recommend that you take time to complete the secure Snoring and Sleep Apnea Questionnaire and Epworth Sleepiness Scale. If you have a bed partner, we recommend that you complete the forms together in order to help our doctors begin to obtain an accurate snoring and/or sleep apnea history. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. In addition, please also complete Patient Registration (Medical History) Form and press Submit.
Technical Note:
PC Users
Our online form uses Adobe Acrobat Reader 5 or greater plug-in to conveniently submit the form from home or work. Please download the free plug-in from Adobe's web site if it is not already installed on your system. It is important that you have at least version 5 of the plug-in to successfully use our online form.
Mac Users
You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free plug-in from Adobe's web site.