Patient Forms

Don't want to spend fill out paperwork before your dental appointment? The below forms can be completed before your visit to Mount Airy Pediatric Dentistry to reduce your stress in the dental office.

Printable Patient Forms

The below patient forms can be printed and completed before your visit to Mount Airy Pediatric Dentistry. Please bring the completed forms with you during your appointment.

Notice of Privacy Practices Acknowledgement

Click here to access our Notice of Privacy Practices Acknowledgement form to download, print, or complete ahead of time.

Patient Registration Form

Click here to access our Patient Registration Form to download, print, or complete ahead of time.

Pediatric Dentist Near You

Address:

202 Rawley Ave Unit 1
Mount Airy, NC 27030

Phone:

(336) 415-7777

Hours

Monday: 8:00 AM - 5:00 PM
Tuesday: 8:00 AM - 5:00 PM
Wednesday: 8:00 AM - 5:00 PM
Thursday: 8:00 AM - 5:00 PM
Friday: 8:00 AM - 5:00 PM
Saturday: Closed
Sunday: Closed

Your Child’s Health Is In Good Hands

Contact Us Today for an Appointment

Don’t wait, schedule your appointment with our friendly dental team today and keep your smile healthy and bright.