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 Complete and Send 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.


Spanish Online Form

Location: 132nd & Birch (West Maple Rd.)

Doctors: Dr. Robert PfeifleDr. John EngelDr. Steve Coffey


Spanish Online Form

Location: 201 Ridge Street – The Doctors Building at Jennie Edmunson

Doctors: Dr. David MarshallDr. John Andersen


Spanish Online Form

Location: 1437 East 23rd Street

Doctors: Dr. Corey Auch


Spanish Online Form

Location:  1502 So. Washington Street

Doctors:  Dr. Steve Wendt


Information about our secure online patient registration form can be found here:

https://pbhssupport.zendesk.com/hc/en-us/articles/200164224-TruForm-Classic-Security-Information

Please contact us with any questions.