Conformational changes of proteins adsorbing on biomaterial surfaces affect biocompatibility. Titanium is among the most successful biomaterials; however, the mechanisms leading to its biocompatibility are not yet understood. The primary objective of this study was to investigate the conformation of human plasma fibrinogen (HPF) adsorbed on titanium oxide surfaces. A method for preparing ultraflat titanium substrates was developed. This allowed high-resolution investigation of both the titanium oxide surfaces and the adsorbed state of HPF. The titanium oxide surfaces were first imaged with an atomic force microscope in air and subsequently incubated in a solution of HPF in phosphate buffer and imaged in fluid with tapping mode AFM. The titanium oxide surfaces exhibited a root-mean-squared (RMS) roughness of (0.29 ± 0.03) nm over (1.00 × 1.00) μm2 areas. Different degrees of molecular order were found on the titanium oxide surface. In crystalline surface areas square lattices with parameters a0 = b0 ≈ 0.5 ...