We ask our new patients to print and sign the new patient forms below and bring them to your first appointment.

The “Receipt of Privacy Notice” is for your records.  The “Patient Release of Information”  must be signed if you are transferring dental records from another office. The “Authorization to Consent to Health Care for a Minor” is to be used if someone other than the parent or guardian will make consent to care.  Each form is a PDF for convenient downloading and printing.

Please call us at 704-373-6040 if should have any issues or questions regarding our patient and privacy forms.

Privacy Policy
This form, Notice of Privacy Practices, presents the information that federal law requires us to give our patients regarding our privacy practices.

Please click on the box below to view and print your form.  Thank you.