Forms

Update Medical History For Current Patients
For our current patients that have not been seen in our office for 3 years or more, we will need the following forms to be filled out for each patient. All forms will need to be filled out please.

*  Please arrive 15 minutes PRIOR to your appointment

New Patients
Please download the forms below (one for each patient) and please bring them with you to your appointment. All forms will need to be filled out please.
Please arrive 15 minutes PRIOR to your appointment

Changing Dentists
For CURRENT patients that are needing to change dentists please print this form and fill out in its entirety and you may fax to (704) 509-4516 or email to info@universitydentist.com


adobe
These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo above to download.

  
2770 East W.T. Harris Blvd., Suite 102, Charlotte, NC 28213   P : (704) 509-4513   F : (704) 509-4516

Site Map | 2011 © All Rights Reserved | Privacy Policy | Dental Website By: Televox®    Administration