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201 Providence Road • Charlotte NC 28207 • Contact Us

Patient Forms


New Patient Forms

Please click on the files below to open, print and bring completed forms to your appointment.

New Patient Registration Notice of Privacy Practices (2017) Informed Consent Records Release Authorization

Most all traditional insurance accepted as well as network providers for Cigna, Delta Dental, Aetna, Ameritas, MetLife, Unicare and United HealthCare.

Bring your whole family to one convenient location for all their dental needs.
…Treat Others As You Would Have Them Treat You … Matthew 7:12