New Patient Forms

All new patients are required to fill out a registration, medical history, and HIPPA policy form. For your convenience, you can print the documents and fill them out prior to your appointment. Be sure to bring them with you along with a current insurance card, if you have dental coverage, on your date of service.

If the patient we are seeing is a minor, we require the parent or legal guardian to fill out a consent form.

  • 2012 HIPPA form coming soon

adobe

These forms require Adobe Acrobat Reader. If you do not have Adobe Reader already installed on your computer, click the Adobe logo to download.

En Espanol:

  • 2012 HIPPA form coming soon

Appointment Hours
Mon. - Thurs. 8:00am - 5:00pm
Fri. 8:00am - 2:00pm

Contact Numbers
(336) 998-2427
Fax (336) 998-1088

After hours, please contact our calling service by calling the office.