Office Forms

Find many of our office forms below to download.  If you have any questions about any of our forms feel free to call us to discuss.

Forms to complete and bring to the 1st visit

Please download and sign the following 5 documents and bring them to the 1st visit:

  • new patient information
  • general consent form
  • acknowledgement of privacy practices
  • release of information authorization
  • scheduling policy

Also read the notice of privacy practices.  You do not need to sign anything with the notice of privacy practices.

Hosptial Treatment (OR) Post Operative Froms

Our OR post operative forms can be downloaded in spanish or english.

Click the the icon next to the form to download a Microsoft Word document that you may print out.

New Patient Information

Please fill out both pages. Fill out the medical history section as thorougly as you can.

General Consent form

This form is our general consent form for visits to our office.

Notice of Privacy Practices

Read this document. There is nothing to sign. HIPPA requires that this document is offered to all patients.

Acknowledgement of Privacy Practices

Sign this after you understand our notice of privacy practices.

Release of Information Authorization

This form allows you to authorize us to discuss you child’s dental information with anyone that may bring your child to an appointment other than the guardians. Note: this allows discussion only, not consent.

Scheduling Policy

Please sign our form that explains our scheduling policy

OR Post Op Instructions

Post operative instructions for treatment in the OR (hospital).

INSTRUCCIONES DESPUÉS DE LA CIRUGÍA

En Espanol

2824 Rogers Rd, Suite 201
Wake Forest, NC 27587

Phone: 919.435.7660
Fax: 919.453.6370