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Patient Forms

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time you will save significant time on your visit. If you have any questions when filling out the form, please do the best you can, and our staff will assist you with your questions on the day of your appointment.

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Downloadable Forms

Financial Policy (PDF)

Insurance Information (PDF)

New Patient Form

Privacy Policy (PDF)

Privacy Policy Signature Page (PDF)

Release of Information (PDF)

*All forms are available in PDF format. To view these files, you need to install Adobe Acrobat Reader to work with your browser. Please note that you need the latest version of Adobe Acrobat Reader to correctly read our forms. If you have problems opening a form, please try to update your version of Acrobat Reader.

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We will schedule your appointment with Winston-Salem Dental Specialists as promptly as possible. If you have pain or an emergency situation, every attempt will be made to see you that day.

We value your time and do everything we can to stay on schedule and minimize your wait. While in our office, please enjoy your stay and have a nice beverage and relax in our serenity room; we also offer free WIFI to take care of some business during your visit. We appreciate your understanding and patience when unpredictable appointment delays occur.

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Winston-Salem Dental Specialists is a member of the following professional organizations (not all doctors belong to all these organizations):
Diplomat of the American Academy of Periodontology (AAP)
Diplomate of the American Board of Periodontology (ABP)
The American Dental Association (ADA)
North Carolina Dental Association (NCDS)
American Dental Society of Anesthesiology (ADSA)
Winston Salem Dental Specialists
Privacy Overview

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