141 Providence Road
Charlotte, NC 28207
Monday - Friday
7:00AM - 5:00PM
> Site Map
Our patient forms can be downloaded and printed from your computer. You can complete these and bring them with you to your first appointment. For security reasons, please do not email us the forms.
All patient information is confidential.
Acknowledgement of Receipt of Privacy Practices
Consent for Use and Disclosure of Health Information
Endodontic Information & Consent
Notice of Privacy Practices
Patient Medical History
Dental Insurance Information
Financial & Fee Information