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Mark A. Johnson Family DentistryWe're Happy When You're Smiling
 

 
 
 

New Patient Registration




We Welcome New Patients!
 
   

Once you have received confirmation of a scheduled appointment,
you may download the following forms.
 
Please fill them out and bring them with you
(or fax them in advance to 336-983-5738):
 
1. Click on the form listed below to download.

2. Please print each form and fill out completely.
*See our "recommended version" to print all forms at one time.

3. Mail, fax or bring completed forms to your first visit.

Click Selected Links To Download Selected Documents


All Six Documents In One
(Recommended Version For All New Patients)
 

Welcome Letter

Patient Consent To Dental Treatment Form

Consent To Release Health Information Form

Our Financial Policy

Dental Registration & Patient History Form (Page 1 Of 2)
Dental Registration & Patient History Form (Page 2 Of 2)
]

Note: To view and print forms, you will need Acrobat Reader.
Click below to download.

Click here to get the FREE Acrobat Reader


 
 

 

 

 

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