Regular Hours: Monday - Thurs 8am-5pm

 

TestimonialsContact Us

704.882.1113

 

New Patient Forms

Our Patient forms are printed in PDF format and can be read using the Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader, receive a free copy by clicking on the button below.

To download the Patient forms click on each link below, then:

  • Print the forms
  • Fill the forms out completely
  • Bring all the forms at your first visit Or Fax forms to 704-882-3711

**Note: After reading the Notice of Privacy Practices, please print the Acknowledgement form below, sign it, and bring or fax it in also.

New Patient Registration
Patient Smile Evaluation Form
Acknowledgement of Receipt of ‘Notice of Privacy Practices’
Family Release of Information
Notice of Privacy Practices [Read Only]

Call 704.882-1113 or contact us

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