Heather J. Brown, DDS
Family Dentistry

7825 Ballantyne Commons Parkway  Suite 200
Charlotte   NC   28277

(704) 544-2141
 

 

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Click to go to Charlotte Magazine

Voted one of Charlotte's
Top Dentists
10 Consecutive Years

2007  2008  2009  2010  2011  2012   2013  2014  2015  2016

 


 

 

 

Patient Forms

 

The following forms can be viewed using Adobe Acrobat Reader (.pdf files).   Click on the form link below to view and print the forms:

 

Registration, Health and HIPAA Forms.pdf
Please print, complete, and bring these forms to your first appointment.  They include a Confidential Registration Form, Confidential Health Questionnaire Form, and a HIPAA Privacy Acknowledgement Form.

 

Privacy Notice.pdf
The Privacy Notice is provided for you to review.  It explains how we care for and protect your confidential health information.

 

Payment Information.pdf
Our Insurance and Payment information explains how we handle your dental insurance if you have insurance and our payment guidelines for any balance of the fees that you may owe.

 

X-Ray Transfer Form.pdf
Send this form to your previous dentist's office authorizing them to send your x-rays to our office.