Help us get to know your child!
Please take a moment and fill out our patient information form before your appointment at our Winston-Salem or Kernersville office. If you have any questions along the way, feel free to contact our practice.
If you would like to fill-out and submit our paperwork online, simply email firstname.lastname@example.org and we will send a digital copy of all necessary documents.
Paperwork to print and fill out at home
- New Patient Form PDF
- Dental Cleaning Form PDF | DOCX
- COVID-19 Screening Form PDF | DOCX
- HIPAA Form PDF | DOC
- Authorization to Release Information Form PDF | DOCX
We look forward to seeing you!
Thank you for taking the time to fill out your paperwork ahead of time. We look forward to seeing you at your next visit!