6865 Fairview Rd

Charlotte, NC 28210

(704) 364-9686

New Patient Forms

For your convenience, you can print out and complete our new patient forms at home before visiting the dental office. Although it's not required, bringing completed forms with you will save time and help make your first appointment fast and easy.

Both the New Patient Information and Patient History forms are located within one PDF document and are Adobe Acrobat files. If you don't have it already, you'll need the free Acrobat Reader to view and print them.

You can bring your completed forms with you or fax them to (704) 364-9160. If you have any problems with the forms, simply call our office and we will gladly email or fax them to you.

Our new patient forms are available in two formats.

Standard Form - If you would like to print your form and fill it out by hand.

Electronic Form - If you would like to fill out your form electronically and then print it out. You also have the ability to email this form. To do so, click on the link and download the form. Once downloaded you can fill out the sections on the form appropriately and save your changes. You can then email the form to us at [email protected]


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