Lewisville Family and Pediatric Dentistry
6570 Shallowford Road • Lewisville, N.C. 27023
Phone: 336.945.5555 • Fax: 336.945-0125

New Patient Forms

We have made our new patient forms available to you as Adobe Acrobat files. For your convenience, we recommend printing and completing 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 Lewisville, NC dental office and we will gladly send or fax them to you.

Adult Forms:

• New Patient Form
• Medical History Form
• HIPPA Acknowledgement
• Financial Policy

Children Forms:

• Patient information and Medical History Form
• Parental Release Form
• HIPPA Acknoledgement
• Financial Policy

Download Adobe Acrobat Reader Now

Call Lewisville Family and Pediatric Dentistry to reserve your appointment with Dr. Browder, Dr. Liner, or Dr. Kinlaw. From our new office in Lewisville, we serve patients from Winston-Salem, Clemmons, Yadkinville, Advance, and beyond with comprehensive care designed for the whole family.