For Our Patients

New Patient Forms – Kids And Family Dental

Save time waiting in our office by filling out necessary forms online, and always feel free to give us a call if you have any questions.

One of the first things new patients consider when choosing Charlotte family dental services is not only the superior care that they can provide, but the costs involved. As you browse through our patient portal, you’ll have a chance to browse the insurance we accept and how we can work with you — because great dental care shouldn’t be a luxury and available to everyone.

You’ll also have the opportunity to complete a medical history, sign a HIPAA release, view our payment policy, and look over our privacy practices — in addition to our consent forms and post-operative instruction forms.

We’re here to not only give you the best smile possible, but make the process goes as smoothly as possible.

Medical History English Medical History Spanish Medical History Update Health History Spanish HIPAA Release English HIPAA Release Spanish
Payment Policy English Payment Policy Spanish Notice of Privacy Practices COVID19 Patient Disclosure English COVID19 Patient Disclosure Spanish STOP BANG English STOP BANG Spanish

Financial Information

When you need dental treatment, cost may be on your mind. We work closely with a number of insurance plans and offer financing so that you can have the dental care you need. If you have questions about your benefits, cost of treatment, or anything else related to payments in our office, give us a call!

Payment Options

For your convenience, we accept the following payment options:

  • Cash
  • Checks
  • Debit cards
  • Visa
  • MasterCard
  • Discover
  • Care Credit Financing

Insurance Plans

We will file for almost any insurance except Medicaid and are in-network providers with:

  • Aetna
  • Ameritas
  • Assurant
  • Blue Cross & Blue Shield
  • Best Life
  • Cigna
  • Connection Dental
  • Delta Dental
  • DenteMax
  • GEHA
  • Guardian
  • Humana
  • Kansas City Life
  • Lincoln Financial
  • Metlife (only certain plans)
  • Principal
  • United Healthcare

To find out more about the insurance plans we work with or to learn about your benefits in our office, give us a call!

Financing Options

We know that fitting the necessary dental care you need into your budget is important. When you incur out-of-pocket expenses, we offer CareCredit financing so that you can pay your treatment off over time. You can get approved online in minutes!

More information about this service: http://www.carecredit.com

Consent Forms

Dental Implant Surgery Bone Grafting Root Canal Therapy
Dental Treatment Extractions COVID Risk Consent Form - English COVID Risk Consent Form - Spanish

Post Operative Instruction Forms

Bone Graft Composite Fillings Crowns and Bridges Dentures
Extractions Implants Periodontal Treatment Root Canal Therapy