Patient Forms

New Patients:

Welcome to our Online Patient Forms Page! Completing your forms online will allow our staff to properly prepare for your first visit. Our New Patient Package contains 6 forms for you to complete. To complete each document you will need to fill out the fields with the requested information. When you have completed a document please review your entries, if everything is correct, click the Next button to move to the next document. Please note that all required fields must be completed before you can click on “Next”. Do not do not use your browser's Back or Forward buttons to navigate between forms as this may cause errors in your entries. Once you have completed all 6 forms and have reviewed all of your entries please click “Submit”. Please note that the information you are submitting will be encrypted for your protection and goes directly to our practice management system. Thank you and please call our office (910) 577-1315 or email [email protected] if you have any questions.

*Please Note That All Forms Must Be Completed on a Desktop Computer*

New Patient Forms Package

Notice of Privacy Practices HIPAA Form (Print for your Records)

Medicare Opt Out Private Contract

Existing Patients:

If you are an existing patient and have been requested by our staff to complete an annual forms update, you may do so by clicking the link below. 

Existing Patient Annual Update Package
Patient Update Form

Medicare Opt Out Private Contract

Teledentistry Form: 

Consent for Teledentistry

Other Online Forms: 

Records Release Form

In order to view or print some of the forms you will need Adobe Acrobat Reader installed. Click here to download it.