Raleigh Pediatric Dentistry-Patient Forms

Patient Forms & Information

The following forms are provided for you to download in preparation of your child's visit to Raleigh Pediatric Dentistry. Please print out a copy, read carefully, and fill out all appropriate forms (*) prior to your child's visit. If you have any questions or concerns, do not hesitate to call us at (919) 845-8212. Thank you for choosing Raleigh Pediatric Dentistry for your child's dental care.

These forms are in PDF format. If you do not already have a PDF reader, please click here to download a free reader

New Patient Forms

Parent Letter

Health History *

General Consent Form *

Appointment Policy

Children, Pediatric Dentistry and You

Financial Policy *

Credit Card Authorization *

Payment Policy

Safety and Privacy

Questionaire for Parents of Patients with Special Needs * if your child has special heathcare needs.