Benjamin F. Dyer, D.D.S.
Phone: 704-554-6104
Fax: 704-554-6004
South Park Towers
6100 Fairview Road
Suite 610
Charlotte, NC 28210
smile4dyer@carolina.rr.com

Best of Charlotte www.RatedBestOfCharlotte.com

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New Patient Forms

We have made our new patient forms available to you, for your convenience, we recommend printing and completing all of these forms at home.

Please remember to bring your completed forms with you for your first appointment.  If you have any problem getting these files to print properly, please call our office and we will gladly send or fax them to you.

 

Adult New Patient Forms

Patient Information
Health Questionnaire
Informed Consent
Office Policy

Child New Patient Forms

Juvenile New Patient Questionnaire
Informed Consent
Office Policy

 


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