These forms are important for clinical care, scheduling, and insurance billing. At your first appointment, time is reserved for review of patient policies, complete paperwork,evaluate dental x-rays, and consult with the dentist about your care.
Required Information That Should Be Brought With You at The First Visit
Two (2) forms of Identification
Insurance Card/Proof of Income
Medication List or List of all Drugs, Supplements, or Natural Products
A note authorizing treatment from doctor if needed (See FAQs)
Doctor(s) names and phone numbers
Guardianship Forms for Children or Adults in Guardianship Care
**If your insurance has not been pre-verified, you will be instructed to bring a deposit for your initial treatment.**
**Please print and fill out each form (English or Spanish)**
We are so thankful for our community members, organizations, and The Health Foundation for their continued support.
We are accepting New Patients. Please call our office at 336-903-9399.
We accept NC Mediciad
Our office is now accepting Cigna, United Healthcare, Delta Dental, and Medicaid insurances. Please call our office to make an appointment.
Questions or concerns about our website should be emailed to email@example.com.
NOTICE TO PATIENTS:
This practice serves all patients regardless of ability to pay.
Discounts for essential services are offered based on family size and income.
For more information, ask at the front office team.
AVISO PARA PACIENTES:
Esta práctica sirve a todos los pacientes, independientemente de la incapacidad de pago.
Descuentos para los servicios esenciales son ofrecidos dependiendo de tamaño de la
familia y de los ingresos.
Usted puede solicitar un descuento en la recepción.
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