Forms

Instructions for Filling-out New Patient Forms

• Please print all forms, fill out completely, and sign where indicated.
• Please provide a written/printed list of all medications.
• Please make a copy of all completed and signed forms, if needed.

BRING ALL FORMS WITH YOU!

Filling out the forms ahead will save you time here at the office. You will be scheduled for clinic time. If the forms are not filled out by the start of your clinical appointment it may be necessary to schedule an additional appointment to complete the gathering of clinical information and will incur an additional expense.

If you have questions, please call us 252-446-0117.

We look forward to meeting you and helping you with your dental needs. Thank you.

Individual forms can be downloaded below.

• Welcome New Patients
• Instructions for Patient Forms
• Demographics
• Medical History
• Broken Appointment Policy
• Notice of Privacy Practices (2026)
• Aviso de Prácticas de Privacidad
• Receipt of Privacy Practices
• Consent for Use and Disclosure of Health Information
• Consent for Prosthodontic Treatments
• Release of Health Information
• Financial Policy
• Request for Antibiotic Coverage