The “New Patient Forms” are for our new patients to print, sign, and bring them to your first appointment. The “Authorization to Release Health Information” ONLY NEEDS TO BE FILLED OUT if you are transferring dental records from another office. If you cannot we ask that you arrive 15 minutes prior to your reserved time to complete this paperwork.
The “HIPAA Notice & Privacy Statement” is for your records. This form presents the information that federal law requires us to give our patients regarding our privacy practices.
The “Authorization to Consent to Health Care for a Minor” is to be used if someone other than the parent or guardian is bringing a minor for an appointment.
Please call us at 704-373-6040 if should have any issues or questions regarding our patient and privacy forms.
Please click on the box below to view and print your form. Thank you.