MCS - Patient Registration 1Parents Information To Patient Information Step 1 - Parent Information Relation Father Mother Step Father Step Mother Legal Guardian Brother Sister Uncle Aunt Cousin Grandmother Grandfather Age: # Sex Male Female State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Important! To complete this registration, you must provide a valid email address. If you don't have an email address, please call our office at (305) 445-9244 and request a code to continue. Bypass Code: Check here if you are the responsible party for the patient(s) that are about to be registered. Check here if you have dental insurance Select Insurance Company DentaQuest AETNA AMERIGROUP ADVANTAGE RISK MANAGEMENT BLUE CROSS BLUE SHIELD CIGNA MEL COVENTRY DELTA DENTAL FLORIDA COMBINED LIFE GUARDIAN HUMANA METLIFE PRIMARY PHYSICIAN CARE UNITEDHEALTH DENTAL MCNA UHC Medicaid Select Policy Save Parent Add Another Parent