accessibility ACCESSIBILITY

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone @ 704-588-7542 or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Office Hours

Monday - Thursday
8:00 a.m. - 5:00 p.m.

If you are a new patient to our Charlotte dental office, the forms below will need to filled out when you arrive for your first appointment in our dental office. Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival.  Thank you and please call our dental office if you have any questions or need any assistance. 

New Patient Registration Form

HIPAA Consent Form


HIPAA Notice of Privacy Statement

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 


Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):
 
 

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.