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)**




**Visit Mobile Clinic section for Mobile clinic paperwork**
Please note, a copy of our privacy policy is available on this website. Click on the link above labeled "Privacy Policy."
Our office fax number is (336) 903-0464.
Appointment request
Need an appointment with a dentist in North Wilkesboro ? Requesting an appointment at our North Wilkesboro, NC family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with us today!
Patient Name*
Phone Number*
Email Address
Are you a current patient?
Best time(s) to call?
Preferred Appt Date
Preferred Appt Time
Describe the nature of your appointment or any other comments