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accessibility ACCESSIBILITY

If you are a new patient, please fill out both pages of the registration form below BEFORE you arrive for your appointment. Filling them out before your scheduled appointment will allow us to attend to your dental needs more quickly. 

You may also fax a copy of the completed registration form along with a copy of your dental insurance card to our office at: 336-236-9555 or email them to us at: nclexingtondental@gmail.com

Thank you and please call our office if you have any questions or need any assistance. 

New Patient Registration Forms

Registration_Form_pg1.pdf

Registration_Form_pg2.pdf

Registration_Spanish_Form_pg1.pdf

Registration_Spanish_Form_pg2.pdf

HIPAA Privacy Act (coming soon)

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