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.

Patient Registration Button

Choose Rockford Oral & Maxillofacial Surgery for Excellent Care

Dr. Bruksch can place dental implants, extract wisdom teeth, and perform several other oral and maxillofacial surgery procedures. Contact us to learn more!

Call us: 815-226-4700