Patient Forms for Visits to Our Family and Cosmetic Dentist in Charlotte NC
We have made our new patient forms available to you as Adobe Acrobat files. For your convenience, we recommend printing and completing these forms at home.
Please remember to bring your completed forms with you for your first appointment with our cosmetic dentist in Charlotte NC. If you have any problem getting these files to print properly, please call our office and we will gladly send or fax them to you.
- Patient Consent Form
- HIPAA Form
- HIPAA NOTICE OF PRIVACY PRACTICES
- The Practice Guidelines
- Patient Medical History Form
- Child Health/Dental History Form
- Credit Card Authorization Form
- The Appointment Guidelines
Your initial appointment will consist of an exam and consultation, which will include:
- Any necessary x-rays, photos, and models.
- An exam of your teeth and gums.
- A discussion about your concerns.
- A consultation and a treatment sequence.
If there is a complex medical history or complex dental problem, it may require a more extensive evaluation and work up and a second consultation appointment.
Please assist us by providing the following information at the time of your initial appointment:
- Any dental records and x-rays that you may have. If your records and x-rays are at another office, please obtain a copy and bring to your initial appointment.
- A list of medications you are presently taking. If you have medical or dental insurance, bring the necessary completed forms.
- This will save time and allow us to help you process any claims.
IMPORTANT: All patients under 18 must be accompanied by a parent or guardian during the consultation visit.
Please alert the office if you have a medical condition that may be of concern such as artificial heart valves and joints, mitral valve prolapse, rheumatic fever, diabetes, high blood pressure, or if you are on any medication such as heart medications, aspirin, anticoagulant therapy, etc. Some patients may require preventive antibiotics before dental treatment.