Durham Pediatric Dentistry & Orthodontics

Patient Forms

Serving Durham, Chapel Hill, Cary, Apex, and the surrounding areas

New Pediatric Dental Patient Forms

Please complete a copy of our Health History Form and bring it with you to your appointment.

Also — if your child has been seen by another dentist, please contact that office (at least two weeks in advance) and request that your child’s x-rays and dental history be sent to us. This will not only provide us with important information but could also avoid duplication of x-rays for your child and help minimize your costs.

Consent Forms

If someone other than the child’s legal guardian will be bringing them to their appointments, please complete the “Authorization to Accompany a Minor” consent form below.

New Orthodontic Patient Forms:

Please complete a copy of our Health History Form and bring it with you to your appointment.